Relationship between occupational noise exposure and renal function impairment in oil workers / 环境与职业医学

Background The current oil production determines oil workers’ occupational noise exposure. Without effective protection, noise will affect various aspects of worker’s body functions, including acting on the adrenal cortex system and resulting in renal function damage. Objective To evaluate the associations of noise exposure and its cumulative exposure level with renal function impairment of oil workers. Methods Oil workers from a collective medical examination in a hospital were selected as the study subjects. In accordance with the national standard Measurement of Physical Agents in the Workplace Part 8: Noise (GBZ/T 189.8—2007), noise exposure was measured three times at the oil workers' work site, and their average value was calculated to obtain the cumulative noise exposure (CNE). A questionnaire survey was conducted to collect general information such as socio-demographic characteristics, family history, lifestyles, and occupational history. All blood biochemical indicators were measured in the fasting state. Renal function impairment was judged based on the glomerular filtration rate. The relationship between CNE and renal function was analyzed using receiver operating characteristic curve (ROC) for workers with noise exposure. Results A total of 2 917 subjects were included in the study and their prevalence of renal function impairment was 14.2%. The univariate analysis results suggested statistically significant differences in the prevalence of renal function impairment among the oil workers grouped by having hypertension or not, gender, age, marital status, marital status, smoking, and alcohol consumption (P＜0.05); the prevalence of renal impairment was significantly higher in those with abnormal values of uric acid, total cholesterol, triglycerides, high-density lipoprotein, and fasting glucose than in those with normal values (P＜0.05); the oil workers with noise exposure [n=1565, 53.7%, equivalent sound level ≥80 dB(A)] showed a higher prevalence of renal function impairment than those without (P＜0.05). The results of multiple logistic regression analysis showed that being female (OR=2.811, 95%CI: 1.960-4.030), age at 31 years and above (OR31-40=3.502, 95%CI: 1.402-8.751; OR41-50=4.255, 95%CI: 1.759-10.291; OR≥51=7.179, 95%CI: 2.864-17.996), showing abnormal uric acid (OR=5.932, 95%CI: 4.486-7.843), having hypertension (OR=1.593, 95%CI: 1.230-2.063), alcohol consumption (OR=2.648, 95%CI: 1.346-5.212), and smoking (OR=1.816, 95%CI: 1.133-2.911) had higher risks of developing renal function impairment; besides, those exposed to noise had 1.351 times (95%CI: 1.073-1.702) higher risks of developing renal function impairment than non-exposed individuals. Noise-exposed oil workers in the renal impairment group had higher noise exposure intensity and CNE compared to the noise-exposed oil workers in the normal renal function group (P＜0.05), and the workers had an increased risk of renal function impairment when the CNE was >95.85 dB(A)·year versus CNE ≤ 95.85 dB(A)·year (OR=2.583, 95%CI: 1.956-3.411). Conclusion Exposure to noise, higher noise exposure intensity, and higher level of CNE may be associated with developing renal function impairment in oil workers. Oil workers with CNE above 95.85 dB(A)·year are at an increased risk of renal impairment.

Characterization and function study of circadian rhythm gene CtPRR1 in Carthamus tinctorius L / 药学实践杂志

Objective To explore the effect of circadian rhythm genes on flavonoids biosynthesis in safflower and its molecular mechanism. Methods Based on the transcriptome and metabolomic database of safflower corolla, we screened the circadian rhythm genes that correlate with biosynthesis of flavonoids in safflower. qPCR was used to quantify the expressions of circadian rhythm genes in different flowering stages at different time points in a single day. LC-MS was performed to determine the accumulation of flavonoids. The correlation between them was analyzed as well. Yeast Two-Hybrid experiment was used to verify the interactive proteins of these genes. Results Seven circadian rhythm genes PRR1, PRR2, ELF3, FT, PHYB, GI and ZTL were obtained. PRR1 gene was positively correlated with flavonoids accumulation (r≥0.7). The full length of PRR1 is 3 201 bp, encoding 421 amino acids, which is highly homologous with rice OsPRR73 gene and named as CtPRR1 (GenBank accession number: MW492035). CtPRR1 was mainly expressed in flowers, and the expression level increased in the daytime and declined in the evening gradually. Correspondingly, the content of flavonoids showed an opposite variation. Both of them displayed a circadian rhythm with a negative correlation (r≥−0.7). In addition, 2 heat shock proteins along with 3 AP2 transcription factors interacting with CtPRR1 protein were obtained via Yeast Two-Hybrid experiment. Conclusion CtPRR1 negatively regulated the safflower flavonoids accumulation in a circadian rhythm way, which may be affected by these interacting proteins.

Characterization and function of short-chain dehydrogenases/reductases in hydroxysafflower yellow A biosynthesis pathway / 药学实践杂志

Objective To explore the function of short-chain dehydrogenases/reductases (SDRs) in safflower flavonoid, especially hydroxysafflower yellow A (HSYA) biosynthesis. Methods SDRs involved in HSYA biosynthesis pathway were screened based on safflower transcriptome database and metabolome database. The expression pattern was analyzed by qRT-PCR. The overexpression vector was constructed by seamless cloning technology, then genetically transformed to the Yunnan Weishan safflower strain by Agrobacterium gv3101. The transgenic T2 generation plants were positively verified, and the gene expression of corolla SDRs was analyzed. The content of secondary metabolites was assayed by UPLC-Q-TOF/MS. Results Three SDRs genes named CtSDR1, CtSDR2 and CtSDR3 involved in HSYA biosynthesis pathway were screened. Their expression in safflower from high to low was corolla > leaf > stem > root. The expression level in corolla increased gradually with corolla development. qRT-PCR analysis of corolla with positive verification of genome insertion sequence showed that the transcription level of CtSDR3 in corolla of T2 positive plants increased by 2~3 times compared with the blank control group, and the content of secondary metabolite HSYA increased by 7.1%~16.6% (P< 0.05). Conclusion CtSDR3 may be involved in the biosynthesis of flavonoids, especially HSYA, in safflower. It provides the support data for explaining the function of CtSDR3 in HSYA biosynthesis pathway.

Dual Immunotherapy in Advanced Non-small Cell Lung Cancer: the Progress and Clinical Application / 中国肺癌杂志

Programmed cell death protein-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) inhibitors and PD-1 inhibitors plus chemotherapy combination regimens have been widely used in the first-line treatment of advanced non-small cell lung cancer(NSCLC), but patients with low PD-L1 expression have limited objective response and survival benefits. Existing treatment regimens are still difficult to fully meet the clinical needs of patients in the real world. Therefore, researchers are still exploring novel superactive treatment options to further improve the efficacy and survival prognosis of different sub-groups in NSCLC. Dual immunotherapy [such as the combination of PD-1 and cytotoxic T lymphocyte associated antigen-4 (CTLA-4) inhibitors] has shown considerable long-term survival benefits in a variety of tumors and has also shown broad clinical prospects in NSCLC. In addition to exploring different emerging combination options, how to accurately identify the optimal-benefit groups through predictive biomarkers and how to effectively manage the safety of combination immunotherapy through multidisciplinary collaboration are also the focus of dual immunotherapy. This article reviews the mechanism of action, research progress, predictive biomarkers and future exploration directions of dual immunotherapy.
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Clinical investigation on the related factors for the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease with carbon dioxide retention / 中华危重病急救医学

Objective:To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with carbon dioxide (CO 2) retention, and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure. Methods:The AECOPD patients with CO 2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled. The general information, past history, times of acute exacerbations within 1 year, pneumonia on admission, causes of COPD, heart failure, blood gas analysis, eosinophil count (EOS), albumin (Alb) and apolipoprotein E (ApoE) levels, exhaled nitric oxide (FeNO) level, inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected. The patients were divided into recommended dosage group (exposure levels in the recommended dosage range, cumulative prednisone dosage ≤ 200 mg) and exceeded group (exposure levels exceeded the recommended dose, cumulative prednisone dosage > 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO 2 retention. Results:According to the order of hospitalization, 151 AECOPD patients with CO 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaO 2/FiO 2), arterial partial pressure of carbon dioxide (PaCO 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with CO 2 retention were FEV1% at stable phase [odds ratio ( OR) = 0.957, 95% confidence interval (95% CI) was 0.921-0.994, P = 0.023], acute exacerbation frequency within 1 year ( OR = 1.530, 95% CI was 1.121-2.088, P = 0.007), heart failure ( OR = 3.022, 95% CI was 1.263-7.231, P = 0.013), PaCO 2 ( OR = 1.062, 95% CI was 1.010-1.115, P = 0.018) and EOS at admission ( OR = 0.103, 95% CI was 0.016-0.684, P = 0.019), aerosolized inhaled glucocorticoids ( OR = 0.337, 95% CI was 0.145-0.783, P = 0.011) and non-invasive mechanical ventilation at acute exacerbation ( OR = 0.422, 95% CI was 0.188-0.948, P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCO 2 were risk factors. Conclusions:For AECOPD patients with CO 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCO 2 can increase systemic glucocorticoid exposure.

Core Technology of Wearable Multi-parameter Patient Monitor / 中国医疗器械杂志

Multi-parameters patient monitors are widely used in hospitals as medical device products, which have important clinical value. It expounds the core technologies of a miniature wearable multi-parameters patient monitor, and looks forward to its application prospects. In addition to traditional applications, when combined with a networked health service platforms, its applications will be greatly expanded in the context of big data and artificial intelligence technologies. The laboratory prototype of this product has been completed and has achieved the anticipative design goal.

Right-sided abdominal evisceration in the treatment of retroperitoneal liposarcoma / 中华普通外科杂志

Objective:To investigate the feasibility and safety of right-sided abdominal evisceration in retroperitoneal liposarcoma.Methods:The clinical data of 16 cases of retroperitoneal liposarcoma performed with right-sided abdominal evisceration at Sarcoma Center of Peking University Cancer Hospital from Sep 2015 to Feb 2019 were analyzed retrospectively.Results:Complete resection were successfully performed in all 16 cases.The median tumor size was 29cm(13-43 cm), the median operative time was 660 min(429-940 min), the median estimated blood loss was 2 000 ml(300-6 000 ml). The major postoperative complications rate (Clavien-Dindo classification Ⅲ-Ⅴ) was 38%. Median overall survival is 41.0 months while the median disease-free survival is 32.6 months.Conclusions:Right-sided abdominal evisceration is a favorable procedure to attain complete resection with acceptable complication rate.

Relationship between shift work and type 2 diabetes in oil workers / 中国职业医学

OBJECTIVE: To explore the relationship between shift work and type 2 diabetes in oil workers. METHODS: A total of 2 666 oil workers in an oil group were selected as the study subjects using the typical sampling method. Questionnaire survey was conducted by a self-designed Questionnaire of Health Assessment for Oil Workers, and blood glucose level was measure. RESULTS: The prevalence of type 2 diabetes in the study subjects was 10.1%(268/2 666). The prevalence of type 2 diabetes in shift workers was higher than that in non-shift workers(13.1% vs 6.0%, P<0.01). After adjusting for the influence of confounding factors such as gender, body mass index, family history of diabetes, history of hypertension, history of hyperlipidemia, and physical exercise, multivariate logistic regression analysis results show that the longer the shift work length, the higher the risk of developing type 2 diabetes(P<0.01), workers with shift work(3 shifts in a day, 2 shifts operating) had a higher risk of type 2 diabetes than that in non-shift workers(P<0.05). CONCLUSION: The shift work length and shift workers with 3 shifts in a day, 2 shifts operating can increase the risk of type 2 diabetes in oil workers.

MiR-212-3p inhibits cell proliferation and promotes apoptosis by targeting nuclear factor IA in bladder cancer

Accumulating evidence suggest that microRNAs play crucial roles in the development and progression of bladder cancer(BC). Here, we found that miR-212-3p was significantly down-regulated and negatively correlated with nuclear factor IA(NFIA) in human BC tissues. Bioinformatics analysis predicted that NFIA was a target gene of miR-212-3p. Then BC celllines, T24 and J82 cells were transfected with miR-212-3p mimics or siNFIA to obtain miR-212-3p overexpression or NFIAknockdown cell lines, respectively. Quantitative real-time PCR was used to determine the expression of miR-212-3p andNFIA. Western blot analysis was utilized to detect NFIA expression. MTT assay showed either miR-212-3 overexpression orNFIA knockdown significantly inhibited the BC cell proliferation. Double staining with Annexin V-APC and 7-AAD showedthe total number of apoptotic BC cells were remarkably increased after miR-212-3p overexpression or NFIA knockdown.Collectively, our results indicated that miR-212-3p targeting NFIA might serve as a promising target for BC.

Targeted therapy of desmoid-type fibromatosis: mechanism, current situation, and future prospects / 医学前沿

Desmoid-type fibromatosis (DF) is a rare monoclonal fibroblastic proliferation that is characterized by locally infiltrative but rarely metastatic lesions. Tyrosine kinase and γ-secretase inhibitors are primarily used in the targeted therapy of DF. The use of these drugs, however, is mainly based on the recommendations of retrospective studies with small sample sizes. Previous studies that focused on the mechanism, efficacy, and safety of targeted therapy for DF were reviewed to provide references for clinical applications and research. The efficacy and safety of targeted therapy were compared with those of other systemic therapy options. Targeted therapy does not provide considerable advantages in efficacy and safety over other medical treatments and is usually applied after the failure of antihormonal therapies, nonsteroidal anti-inflammatory drugs, and chemotherapy. Further studies are required to explore the mechanism, indications, and appropriate drug dosage of the targeted therapy of DF.

Association of effort-reward imbalance and insomnia in steel workers: a structural equation modeling analysis / 中国职业医学

OBJECTIVE: To explore the relationship between Effort-Reward Imbalance(ERI) and insomnia using structural equation modeling. METHODS: A total of 5 769 steel workers from an iron and steel company were selected as study objects by convenient sampling method. The Effort-Reward Imbalance Scale and Five-Item Athens Insomnia Scale were used to investigate their ERI and insomnia respectively. A structural equation modeling was constructed to analyze the relationship between ERI and insomnia. RESULTS: The scores of work effort and internal investment were positively correlated with the score of insomnia [the Spearman correlation coefficient(r_S) were 0.127 and 0.122 respectively, P<0.01]. Work reward scores were negatively correlated with the score of insomnia(r_S=-0.126, P<0.01). We successfully construct a structural equation model between ERI and insomnia in steel workers. According to this model, work effort, work reward and internal investment had direct effect on insomnia [the standardized path coefficient(β) were 0.065,-0.067 and 0.091 respectively, P<0.05]. Work effort and work reward have direct effect on insomnia(the β were 0.048 and-0.010 respectively, P<0.05). CONCLUSION: ERI increases the risk of insomnia. Both effort and internal investment have positive effect on insomnia, while reward has negative effect on insomnia.

Clinical value of uncinate process resection combined with portal-superior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy / 中华消化外科杂志

Objective To explore the clinical value of uncinate process resection combined with portalsuperior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 11 patients who underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis in the Peking University Cancer Hospital (8 patients) and Jilin Guowen Hospital (3 patients) between January 2014 to April 2018 were collected.During the vascular reconstruction,uncinate process of the pancreas was first resected for reducing anastomotic tension,and then end-to-end anastomosis was done after portal-superior mesenteric vein resection.Observation indicators:(1) intraoperative situations;(2) postoperative recovery situations;(3) postoperative pathological examination situations;(4) follow-up and survival situations.Follow-up using outpatient examination and imaging examination was performed to detect patients' postoperative survival,tumor recurrence and metastasis and postoperative venous anastomotic patency up to May 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The non-recurrence and non-metastasis survival curve,overall survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.Results (1) Intraoperative situations:11 patients received uncinate process resection of the pancreas,and successfully underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis.Eight patients underwent distal pancreatectomy + Appleby combined with celiac axis resection due to pancreatic tumor involving common hepatic artery,including 2 undergoing combined total gastrectomy due to gastric ischemia;2 patients underwent distal pancreatectomy;1 patient underwent distal pancreatectomy + distal gastrectomy due to blood supply obstacle of distal stomach.Operation time and volume of intraoperative blood loss of 11 patients were (5.8± 1.1) hours and 800 mL (range,200-2 500 mL).(2) Postoperative recovery situations:there was no grade C of pancreatic fistula of 11 patients.Four patients had grade B of pancreatic fistula,including 2 were cured by drainage-tube indwelling of pancreatic wound ＞ 3 weeks,1 was cured by continous washing due to pancreatic fistula combined with infection,and 1 was cured by the second abdominal puncture drainage due to pancreatic fistula with fever;1 of 4 patients was combined with grade C of delayed gastric emptying and cured by conservative treatment,and other 3 patients didn't occur postoperative complications.Of 5 patients diagnosed as biochemical fistula,1 had esophagus-jejunum anastomotic leakage,and 1 had changes of hepatic ischemia in S2,S3 and S4b segments by CT examination and recovered normal liver function at 2 weeks postoperatively,with long-term hepatatrophia in S2 and S3 segments.There was no postoperative death and reoperation in 11 patients.Duration of postoperative hospital stay of 11 patients was (22± 5) days.(3) Postoperative pathological examination results:tumors of 11 patients were located in neck and body of the pancreas,with a maximum diameter of (4.8± 1.7)cm.Among 11 patients,10 were confirmed with moderate-or low-differentiated ductal adenocarcinoma and 1 with anaplastic carcinoma.The length of portal-superior mesenteric vein resection of 11 patients was (2.6± 0.8) cm.Seven of 11 patients occurred different degrees of tumor infiltration in the portal-superior mesenteric vein,and other 4 patients occurred inflammatory adhesion,without tumor infiltration.(4) Follow-up and survival situations:11 patients were followed up for 3.0-37.6 months,with a median time of 15.7 months.During the follow-up,8 patients died of tumor recurrence and /or metastasis,and 3 survived;the non-recurrence and non-metastais survival time and overall survival time were respectively 9.0 months (range,3.0-37.6 months) and 24.6 months (range,3.0-37.6 months).One patient was complicated with anastomotic stenosis and surrounding varices of portal-superior mesenteric vein by postoperative half-year reexamination,anastomotic vein anomalies and venous thrombosis were not found in other patients before local tumor recurrence and / or death.Conclusion The combined uncinate process resection of the pancreas cannot increase the risk of postoperative pancreatic fistula,and it could effectively reduce the anastomotic tension in the distal pancreatectomy combined with portal-superior mesenteric vein resection and reconstruction,meanwhile,it can also achieve end-to-end anastomosis after longer vein resection.

Promotion of proliferation of prostate in aged rats by low-dose di(2-ethylhexyl) phthalate / 中国药理学与毒理学杂志

OBJECTIVE To investigate the proliferation effect of di(2-ethylhexyl) phthalate (DEHP) on prostate in aged rats at the environmental exposure dose and the possible mechanism.METHODS Thirty-two male Sprague-Dawley rats,aged 1.5 years,were randomly divided into 4 groups (8 rats per group) and treated with DEHP (30,90 and 270 μg· kg-1,ig) and vehicle once daily respectively for 4 weeks.All the animals were anesthetized with pentobarbital sodium and sacrificed on the day subsequent to the last treatment.① Abdominal aortic blood samples were collected,and serum estradiol (E2),testosterone (T) and prolactin (PRL) levels were assayed by ELISA.② The prostate tissues were dissected and categorized into different lobes,weighed and measured.The prostate relative mass was calculated.③ The morphological changes were detected by HE staining and prostate epithelial height was analyzed with microscopic image analysis software.RESULTS Compared with vehicle control group,the prostate relative mass,dorsolateral prostate mass,and dorsolateral prostate index in DEHP 270 μg· kg-1 group were significantly higher (P＜0.05).The height of the ventral prostate epithelium in DEHP 30,90 and 270 μg· kg-1 groups was increased significantly (P＜0.01),so was the height of dorsal prostate epithelium in DEHP 270 μg· kg-1 group (P＜0.01).There were no significant changes in levels of E2,PRL or T in DEHP 30,90 and 270 μg· kg-1 groups,but the ratios of E2/T in DEHP 30 and 270 μμg· kg-1 groups were increased significantly (P＜0.05).CONCLUSION Low-dose DEHP could promote the proliferation of prostatic hyperplasia in the aged rats,which might be associated with the relative levels of endogenous hormone.

Supernumerary nasal tooth a case report / 临床耳鼻咽喉头颈外科杂志

This case report describes a male patient, 5 years old, with recurrent nose congestion and fetid discharge from the right nasal cavity. The suspected clinical diagnosis of a supernumerary nasal tooth was confirmed by computed tomography (CT). Laboratory examination showed normal. After endoscopic removal in general anesthesia, the tooth was examined by pathological examination. A literature search identified 22 supernumerary nasal teeth in 21 patients.

Authenticity,normativity,scientificity and innovativeness of study on drug non-clinical reproductive toxicity / 中国药理学通报

Elements, including experimental personnel, facili-ties, equipment, apparatus, technology and skills, are essential to carrying out pre-clinical reproductive toxicity research. As to a study , authenticity , normativity , scientificity and innovativeness guarantee the success. These four elements are independent of each other,but mutually supported. Authenticity and scientificity are the footstone and soul, respectively, for drug non-clinical re-productive toxicity research. Normativity guarantees authenticity and scientificity, and innovativeness relies on authenticity. Nor-mativity and scientificity ensure the reliability and dynamics of experimental results which perhaps is an effective way accessing innovation.

A retrospective clinical study of urogenital fistula caused by gynecological and obstetrical surgery / 中华泌尿外科杂志

Objective To study the etiology,diagnosis,treatment and prophylaxis strategy of the urogenital fistula caused by gynecological and obstetrical surgery.Methods Data of 64 cases with urogenital fistula,who were admitted into second hospital of Tianjin medical university and Tianjin first central hospital from January 1992 to December 2012,were analyzed retrospectively.In Tianjin first central hospital,those cases include vesicovaginal fistula in 10,ureterovaginal fistula in 7 and urethro-vaginal fistula in one case.In second hospital of Tianjin medical university,those cases include vesicovaginal fistula in 26,ureterovaginal fistula in 18,urethro-vaginal fistula in 1 and ureterouterine fistula in one case.The median age was 42 years old (range 21-53).The history of diseased ranged from 16 days to 30 years.All patients were diagnosed by methylene blue test,cystoscopy,ureteroscopy,intravenous urography,ultrasound,computed tomography (CT) and magnetic resonance urography (MRU).The primary fistula was diagnosed in 50 cases and the recurrence was found in 14 cases.Single fistula existed in 56 cases and multiple fistulas were found in 8 cases.In 36 patients with vesicovaginal fistula,transabdominal repair of vesicovaginal fistula (n =20),transpubic surgery (n=10) and transvaginal surgery (n=6) were chosen.In 25 patients with ureterovaginal fistula,ureterocystostomy (n =10),ureterotomy with holmium laser (n =8),ureteral stent placement (n =6) and ureteral stricture excision and bladder-psoas suspension (n=1) were used.Two patients with urethro-vaginal fistulae were cured by the Latzko technique.One patient had uretero-uterine fistula and cured by ureteral stricture excision,ureterocystostomy and bladder-psoas suspension.Results Fifty-five(86％) cases were cured by single-stage surgical treatment and nine patients experienced more than two times of surgical treatment.The incipient patients have a higher success rate of first surgery than recurrent patients (92％ vs.64％,P＜0.05).Single and multiple fistulas have no significant difference about the surgical successive rate (88％ vs.75％,P＞0.05).In cases with vesicovaginal fistula,the success rate of vaginal and abdominal approaches are the same 85％ (P＞0.05).In cases with ureterovaginal fistula,abdominal and endoscopic approaches were 100％ and 85％,respectively (P＞0.05).The mean duration of follow was 20 months (range 3-48).There was no recurrence during follow-up.Conclusions Urogenital fistula caused by gynecological and obstetrical operation can be cured by surgery.Recurrent fistula is a challenge for diagnose and treatment,preoperative need reasonable operation mode to improve the success rate of operation.Both open surgery and endourology approaches are effective treatment options in management the urogenital fistula.

Construction of a cross-territory flap on the mouse’ s ear / 中国比较医学杂志

Objective To establish a mouse ’ s cross-territory ear flap that enables chronic , in-vivo observation of the change of vascular morphology .Methods 30 ICR mice, weighing 25~40 g, were used for this study .Commercial depilatory cream was used to first remove the hair of the mice , after which the vascular pattern in the ears was investigated . According to the observation of the vascular pattern in the mouse ’ s ear, the eye scissors were used the sever the outer 2/3 of the base of the ear , in which process a ear ’ s flap based on a vascular pedicle but crossed three vascular territories was created.After the creation of the flap , the mice were placed on an automatic controlled movable machine with the ear ’ s flaps spread over a customized Plexiglas .Then the flaps were photographed under the stereoscope ( ×25) at the following time points:1,2,3,5,7,10,14,21,30 d.the necrosis of the flap, and the morphological change of the vessels within theflap were analyzed .Results The ICR mouse ’ s ear was supplied three angiosomes , which were respectively named as the cephalic , median and caudal angiosomes from inside out .Five days after the flap’s creating, necrotic rate of(15 ±7)%was developed .The choke vessels between the medial and median angiosomes expanded rapidly in diameter , reaching the plateau 10d after flap creation, resulting the dilated choke veins and arteries at their peak being 3.9 ±0.5 and 3.5 ±0.7, respectively, than their initial sizes.The diameter of the choke veins began to shrink at approximately 10d, stabilizing after 21d.The diameter of the choke arteries plateaued and stabilized at around 10d.Conclusion ①after harvest of extended flap, the dilation of veins seemed to passive , whereas the dilation of arteries seemed to active;②the number of the choke vessels between the dynamic and potential territories that are involved in dilation and extent of the dilation are much smaller than that of the choke vessels between the anatomic and dynamic territories;③the mouse ’ s ear flap is an excellent model of further study of mechanism underlining the dilation of choke vessels and for the screening of vasoactive drugs that augment the survival of the large flap .

A scoring system for prediction of early recurrence after liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The management of Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) is controversial due to the early recurrence after curative hepatectomy, and many variables were related to the prognosis. The purpose of this study was to predict the tumor recurrence in early postoperative period of the patients with BCLC stage B HCC.</p><p><b>METHODS</b>From January 2004 to January 2012, 104 patients with BCLC stage B HCC underwent hepatectomy. Clinicopathological factors and follow-up data were statistically analyzed to establish a predicting scoring system.</p><p><b>RESULTS</b>The overall survival rates for one, three, and five years were 69.2%, 52.7%, and 42.3%, and the disease-free survival rates for one, three, and five years were 52.9%, 47.3%, and 37.5%, respectively. The multiple factors analysis showed that the micro-vessel invasion, lymph nodes metastasis, multiple lesions, and the high expression of HMGB1 were independent factors (P < 0.05). A scoring system was established to predict the early recurrence within one year after the surgery for BCLC stage B HCC, according to the analysis results with a specificity of 85.1% and a sensitivity of 80.3%.</p><p><b>CONCLUSION</b>Variant clinicopathological factors were associated with early postoperative recurrence for BCLC stage B HCC and recurrence early after hepatectomy was more likely in patients with a higher score of the scoring system.</p>

Application of CT values in calculation of proton incident energy in proton treatment planning system / 中华放射医学与防护杂志

Objective To explore the application of CT value in calculating the proton incident energy in proton treatment planning system. Methods Bethe-Block formula and the formula for calculating the proton range were analyzed to study the correlation of the range of proton beam ( 70-250 MeV ) between a variety of radiation equivalent material and water. Procedure of Monte Carlo SRIM2008 was used to verify the possibility of a constant proportional coefficient of range ( Ci ). The proportional coefficient ( Ci ) of range in radiation-equivalent material and the CT value were fitted by using Origin 8.0 software to study the functional relation of CT value and Ci. The actual range of proton was equivalent to a range of water and incident proton energy could be calculated. Results There was a constant range of Ci of proton beam (70-250 MeV) between a variety of radiation equivalent material and water. There was a functional relation between CT value and Ci ( r = 0.999). The actual range of proton in radiation equivalent material can be equivalent to a range of the water. Conclusions CT values and a range of proportional coefficient ( Ci ),and the actual required range of the tumor could be used to accurately calculate the water equivalent range,and the incident proton energy to the position of Bragg peak. A new exploration for using CT technology in proton treatment planning system could be obtained.

A clinical study of low molecular weight heparin on the treatment of disseminated intravascular coagulation prophase state in pregnant woman / 中国医师杂志

5.0mg/L were randomly divided into LMWH treatment group and low molecular dextran treatment group with 20 patients in each group.The patients in LMWH group were treated with 0.3ml LMWH subcutaneous injection in abdominal wall in every 12h for 1-4 d.The patients in low molecular dextran group were treated with 500ml low molecular dextran plus 20ml danshen root,intervenous drop infusion for 1-7d.Results The D-Dimer blood serum level in the gestational late period was significantly higher than that of nongravida group(P