Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system / 中国骨伤

OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

A pair of new phenylpropanoid enantiomers from Cordia dichotoma fruits / 药学学报

The ethyl acetate part of the alcoholic extract of Cordia dichotoma fruits was purified by a combination of normal-phase silica gel column chromatography, Sephadex LH-20 gel column chromatography and semi-preparative HPLC, and the structure was identified by modern spectroscopic techniques (UV, IR, MS, NMR). A total of 10 compounds were isolated and identified as cordilide (1), (S)-2-hydroxy-3-(4′-hydroxyphenyl) propanoic acid (2), vanillic acid (3), p-coumaric acid (4), 3-hydroxy-1-(4-hydroxy-3-methoxyphenyl)propan-1-one (5), benzoic acid (6), p-hydroxypropiophenone (7), p-hydroxyacetophenone (8), 5′-methoxyevofolin B (9) and vanillin (10). Among them, compound 1 is a pair of new phenylpropanoid enantiomers, and compounds 3, 6, 8 and 9 were isolated for the first time from the genus.

Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the morphological, histological and ultrastructural changes of acute closed rupture of Achilles tendon, in order to clarify the pathological basis of the injury and to explore the significance.@*METHODS@#From January 2015 to January 2019, 35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients, 12 cases in acute open Achilles tendon rupture group included 10 males and 2 females, with an average age of (35.1±9.7) years old ranging from 19 to 50, and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females, with an average age of (35.5±6.6) years old ranging from 18 to 50, and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining, scanning and fluoroscopic electron microscopy, immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation, the collagen fiber degeneration and local fat infiltration, collagen fiber shape, cell morphology and function, and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups.@*RESULTS@#Compared with the acute open Achilles tendon rupture group, the acute closed Achilles tendon rupture group had poor elasticity, hard texture, moderate edema, irregular shape of Achilles tendon broken end, horsetail shape, and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly, with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively, and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group, and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05).@*CONCLUSION@#The morphology, histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained, part of collagen Ⅰ is replaced by collagen Ⅲ, and the toughness and strength of the tendon tissue decreased, which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture.

Analysis of the effect of pentoxifylline on oxidative stress in brains of epileptic rats based on Nrf2-ARE signaling pathway / 医学研究生学报

ObjectiveTo investigate the effects of pentoxifylline (PTX) on oxidative stress in brains of epileptic (EP) rats based on the nuclear factor E2 related factor 2 (Nrf2) antioxidant response element (ARE) signal pathway.MethodsThirty-six healthy and adult male Wistar rats were included in the experiment and were divided into blank control group (peritoneal injection of isotonic saline), EP control group (induced EP episode), and PTX group (induced EP episode ＋ PTX pretreatment) according to a completely random method, then 12 rats in each group. The behavioral changes of rats in each group were monitored, and the EP attack rate and seizure latency were recorded. The rats were sacrificed to collect substantia nigra and hippocampus for testing oxidative stress indicators and expression levels of Nrf2 ARE signaling pathway-related proteins.ResultsNo abnormal reaction was observed in the control group after treatment. The EP attack rate in the EP control group reached 83.33%. The EP attack rate (33.3%) and the attack level ((2.14±0.40) vs (3.09±0.58)) in the PTX group were significantly lower than those in the EP control group, and the seizure latency was significantly longer than that in the EP control group (P0.05) ). The expression of substantia nigra tissue was significantly higher than that of the blank control group (P<0.05).ConclusionPTX can inhibit EP seizure and improve the oxidative stress in the brain of rats at the early stage of EP. The possible mechanism is that PTX can specifically activate Nrf2 ARE signaling pathway.

Effects of AdipoRon orally on the functions of spleen and pancreas in type 2 diabetic mice / 中国应用生理学杂志

OBJECTIVE@#To observe the effects of AdipoRon orally on the functions of spleen and pancreas in type 2 diabetic mice, in order to present data for clinical application.@*METHODS@#Forty C57/BL6 male mice were randomly divided into 2 groups: normal control group (n=10) and model group (n=30), the former group was fed normally, while the later group was fed with high fat and sugar for 4 weeks.After that, type 2 diabetes model was established in DM group induced by intraperitoneal injection of streptozotocin (STZ, 40 mg/kg).As type 2 diabetes model established successfully, the model mice were randomly divided into three groups (n=10): diabetes mellitus (DM) group, high dose of AdipoRon group (DM + H) and low dose of adiponRon group (DM + L).All the four groups were treated with saline, saline, AdipoRon at the doses of 20 mg/kg and 50 mg/kg by gavages respectively, once a day for 10 days.And then put them to death for collecting blood, pancreas and spleen.Pathological changes of pancreas were observed with a light microscope after HE staining.Protein contents of insulin receptor (INSR), insulin receptor substrate 1( IRS-1) and tumor necrosis factor-α(TNF-α) in pancreatic and spleen tissues were detected by ELISA.The protein level of phosphorylation insulin receptor substrate 1(p-IRS-1) in pancreas was determined by Western blot, and the expression of insulin mRNA in pancreas was tested by RT-PCR.@*RESULTS@#Under the light microscope, it was visible that the pancreatic tissue in NC group was full and closely packed, and the islet was big.Pancreatic tissue of DM mice was incompact and the islet of DM mice was smaller than that of normal mice.As for the mice treated with AdipoRon orally, the pancreatic tissue was full and closely arranged, and the islet was slightly smaller.Compared with NC group, the levels of TNF-α in pancreas and spleen of DM group were increased markedly, the levels of INSR and IRS-1 were decreased, the spleen coefficient, p-IR-1 protein level and insulin mRNA expression in pancreas were decreased, all were significant statistically (P＜0.05).Compared with DM group, the levels of TNF-α in pancreas and spleen of AdipoRon groups were decreased, the levels of INSR and IRS-1 in pancreas and spleen of AdipoRon groups were increased, while the spleen coefficient was increased (P＜0.05).The p-IRS-1 protein level and insulin mRNA expression in pancreas in DM+H group were increased (P＜0.05).Compared with DM + L group, the level of TNF-α was decreased, and the levels of INSR and IRS-1 were significantly increased (P＜0.05) in DM + H group (P＜0.05).@*CONCLUSION@#Oral administration of AdipoRon can protect the spleen and pancreas of diabetic mice by decreasing the inflammatory response, up-regulating the expression of INSR, and increasing p-IRS-1 level in diabetic mice.

Effect of Drug-containing Serum of Clerodendrum bungei on Liver Cancer Cells Through PI3K/Akt Signaling Pathway / 中国实验方剂学杂志

Objective: To investigate the effect of Clerodendrum bungei-containing serum on liver cancer MHCC97-H cells and its possible mechanism from the perspective of phosphatidylinositol 3-kinase(PI3K)/protein kinase (Akt) signaling pathway. Method: The medicinal serum of 15% C. bungei was used to treat MHCC97-H cells. The effect of serum containing C. bungei on cell proliferation was observed by cell counting kit-8(CCK-8) method, in order to select the best time and concentration. The apoptosis was detected by Annexin V-FITC/PI double staining method. Western blot was used to detect the posphatase and tensin homologous gene deleted from chromosome 10 in key proteins (PTEN), phosphoprotein kinase B (p-Akt) and phosphatidylinositol 3-kinase (PI3K)-related protein expression of PI3K/Akt signaling pathway. Real-time PCR was used to detect C. bungei-containing serum on cells for 72 h after activation of nuclear factor-activated B cell kappa light chain(NF-κB) and tumor necrosis factor-α (TNF-α) mRNA expression. Result: The results of CCK-8 showed an inhibitory effect of the C. bungei-containing serum on the proliferation of tumor cells in a dose and time-dependent manner. Among them, the high-dose group had the most obvious inhibitory effect, and the maximum inhibition rates at 24, 48,72 h were 28%, 32%, and 43%, respectively. The results of flow cytometry showed that with the increase of drug-containing serum concentration, the cell growth was observed. The inhibition rate of cells was increased to different degrees, and the inhibition effect was significantly increased in the 72 h intervention group (PC. bungei-containing serum group was 19.48% and 19.72%, compared with the blank group. The difference was significant (PC. bungei-containing serum (PPC. bungei-containing serum could down-regulate the expression of NF-κB and up-regulate the expression of TNF-α mRNA (PConclusion: The medicinal serum of C. bungei can effectively inhibit the proliferation of MHCC97-H hepatoma cells and promote its apoptosis, which may be related to the PI3K/Akt signaling pathway and its key factors.

The intervention effects of AdipoRon on renal injury in type 2 diabetic mice / 中国应用生理学杂志

OBJECTIVE@#To study the effects of adiponin receptor agonist (AdipoRon) on renal injury in type 2 diabetic mice.@*METHODS@#The experiment was carried out on 40 SPF C57/BL6 male mice and they were randomly divided into normal control group (=10) and experimental group (=30). Mice in experimental group were given with high sugar and high fat feed in combination with only an intraperitoneal injection of small dose of streptozotocin to build the model of type 2 diabetes (T2DM), which were randomly divided into three groups, model control group (DM), low dose AdipoRon group (DM + L) and high dose AdipoRon group (DM+H)(=10). Then the change of blood glucose was detected. The serum levels of insulin receptor (INSR), insulin receptor substrate-1 (IRS-1) and tumor necrosis factor-α (TNF-α) in mice were measured by ELASA. Pathological changes of renal tissues were observed with a light microscope after HE staining. The expressions of pancreatic duodenal homebox-1 (PDX-1) and insulin mRNA in renal tissues were detected by RT-PCR. The content of phosphated insulin receptor substrate-1 (p-IRS-1) protein in the kidney was determined by Western blot.@*RESULTS@#Compared with DM mice, blood glucose and TNF-α levels in DM + H mice and DM + L mice were significantly reduced (<0.05), while the expressions of INSR,IRS-1 and the content of p-IRS-1 were increased markedly(<0.05), and the expressions of PDX-1 and insulin mRNA in renal tissue were increased significantly(<0.05, <0.01).@*CONCLUSIONS@#Mice treated with AdipoRon have lower blood glucose and TNF-α levels, and higher protein expression levels of INSR, IRS-1, and higher mRNA expression levels of PDX-1 and insulin, and the content of p-IRS-1. All of these indicate that AdipoRon has a certain effects on renal injury in type 2 diabetic mice.

Comparison of laparoscopic and open surgery in treatment of rectal cancer patients / 中国内镜杂志

Objective To compare the effect of laparoscopic and open surgery in treatment of rectal cancer. Methods 80 cases of patients with rectal cancer from May 2008 to May 2013 were selected, they were randomly divided into laparoscopy surgery group (n = 40) and open surgery group (n = 40), the operation time, intraoperative blood loss, length of incision, lymph node dissection, number for the first time, ventilation time, ambulation time, hospitalization time, cost of hospitalization, postoperative complications, treatment satisfaction of the two groups were statistically analyzed. Results The operation time of the laparoscopic surgery group was significantly longer (P < 0.05), the amount of bleeding was significantly less (P < 0.05), the incision length was significantly shorter (P < 0.05), the first time, ventilation time, ambulation time, hospitalization time were significantly shorter (P < 0.05), the hospitalization cost was significantly higher (P < 0.05), the rate of postoperative complications 15.0% (6/40) was significantly lower than the open surgery group 35.0% (14/40) (P < 0.05) 97.5% (39/40), the treatment satisfaction was significantly higher than the open surgery group 67.5% (27/40)(P < 0.05). Conclusion The effect of laparoscopic and open surgery in treatment of rectal cancer is better than open surgery.

Systematic Review on Curative Effect of Small-needle-knife Therapy Combined with Manipulation on Frozen Shoulder / 中国中医药信息杂志

Objective To systematically evaluate the efficacy of small-needle-knife therapy combined with manipulation in treating frozen shoulder. Methods Articles about small-needle-knife therapy combined with manipulation treating frozen shoulder clinical randomized controlled trials in CNKI, CBM, VIP, Wanfang Data, Embase, Cochrane Library and Pubmed database were searched. Retrieval time was from the establisment of the database to February 2017. Two researchers screened literature, extract materials independently. The quality of the included studies was evaluated according to the Cochrane System Evaluation Manual 5.1.0. Meta-analysis was performed by using RevMan 5.3 software. Results 12 articles were included in a systematic review, a total of 1118 cases of patients. Meta-analysis showed that, compared with small-needle-knife therapy alone, small-needle-knife therapy combined with manipulation in the treatment of frozen shoulder could significantly improve the total effective rate [OR=5.07, 95%CI(3.07, 8.37), P<0.000 01] and cure rate [OR=2.89, 95%CI(2.21, 3.78), P<0.000 01], enhance motor function score [MD=63.98, 95%CI(38.61, 89.35), P<0.000 01], with statistical significance. Conclusion Small-needle-knife therapy combined with manipulation had definite efficacy in the treatment of frozen shoulder. However, the quality of included research is relatively low, so large-sample, multi-center and high-quality randomized controlled trials are required for verification.

Antithrombotic effects of ethyl acetate fraction of Curcuma kwangsiensis / 中成药

AIM To study the antithrombotic effects and mechanism of ethyl acetate fraction of Curcuma kwangsiensis S.G.Lee et C.F.Liang (CKEAF).METHODS To observe the antithrombotic effects of CKEAF on tail thrombotic mouse models and arteriovenous bypass thrombotic rat models induced by carrageenan,and in vivo thrombosis rat models induced by FeCl3.The serum levels of ET-1,6-keto-PGF1α,TXB2 in rats were measured by enzyme linked immunosorbent assay (ELISA),and the level of NO was determined by nitrate reductase method.Rat models of acute blood stasis were further established for hemorheological study.RESULTS CKEAF significantly decreased the number and length of blackened thrombotic tail of carrageenan-treated mice.Rat models shared significant wet weight loss in arteriovenous bypass thrombosis and in vivo thrombosis,increased levels of NO,6-keto-PGF1α,decreased levels of ET-1,TXB2,and decreased whole blood and plasma viscosity (rats of acute blood stasis model).CONCLUSION Significant antithrombotic effects by CKEAF may contribute to elevated levels of NO,6-keto-PGF1α,and decreased levels of ET-1,TXB2,and lowered whole blood and plasma viscosity.

Dermal hypoesthesia surrounding the incision after total knee arthroplasty: how to treat? / 中国组织工程研究

BACKGROUND: Dermal hypoesthesia surrounding the incision usually occurs after total knee arthroplasty (TKA), which severely affects the patients' life quality. But the relevant studies are still immature, and its prevention methods and prognosis remain controversial.OBJECTIVE: To review the research and progress of dermal hypoesthesia following TKA.METHODS: A computer-based online research of CJFD, WanFang, VIP and Medline databases was performed for the literature addressing the dermal hypoesthesia surrounding the incision after TKA published from December 2001 to December 2016. The keywords were "total knee arthroplasty, incision, numbness, abnormal sensation" in English and Chinese, respectively. Finally, 36 eligible articles were selected for result analysis after excluding the repetitive ones.RESULTS AND CONCLUSION: (1) Dermal hypoesthesia surrounding the incision following TKA is commonly seen, but the related researches are few. Most of researches concentration on protecting against cutaneous nerve injury by modifying surgical approach, nerve conduit, neural nutrients and surgical repair, but all possess certain shortcomings, so there is a lack ideal prevention scheme. (2) The repairing methods for peripheral nerve injury, including biomolecular, cell and catheter therapies, have been applied in the repair of cutaneous nerve injury following TKA, but still on initial stage,and its effectiveness and safety need to be confirmed in depth. (3) Therefore, whether dermal hypoesthesia surrounding the incision following TKA needs treatment or not, and how to treat is an urgent problem for joint surgeon.

Total hip arthroplasty with collum femoris preserving prosthesis: differences from traditional prosthesis / 中国组织工程研究

BACKGROUND: Traditional total hip arthroplasty can easily lead to the postoperative complications such as prosthetic loosening and subsidence. The unique design concept of collum femoris preserving (CFP) prosthesis, effectively solves the above problems.OBJECTIVE: To summarize the research progress of CFP prosthesis in total hip arthroplasty.METHODS: A computer-based online retrieval in CNKI, CBM, VIP, WanFang, PubMed, Embase, The Cochrane Library,Web of Science databases from1990 to 2017 was performed with the keywords of "collum femoris preserving, CFP, total hip arthroplasty, TKA" in English and Chinese, respectively. The development history of CFP, design concept, surgical indications and contraindications, complications, surgical considerations as well as clinical effectiveness were analyzed and summarized.RESULTS AND CONCLUSION: A total of 41 articles were included. The stress distribution of CFU prosthesis is similar with the physical condition of proximal femur. The preserved normal eccentricity has good resistance to rotation, thus effectively avoiding prosthetic loosening and subsidence resulting from osteoporotic proximal femur, and still keeps more bone reserve for future revision surgery. Most of studies only prove that the CFP prosthesis has a certain curative efficacy, but the differences between traditional and CFP prosthesis remain unclear. A large number of high-quality evidence-based medicine and clinical researches are needed to support the clinical application of CFP prosthesis, thus providing data reference for orthopedic surgeons.

Periprosthetic joint infection following total knee arthroplasty: its bacteriological characteristics and treatment strategies / 中国组织工程研究

BACKGROUND: Periprosthetic infection after total knee arthroplasty (TKA) has become the most serious complication. However, there is still a lack of clinical study on the distribution of pathogenic bacteria. Therefore, understanding the distribution characteristics of the main pathogenic bacteria is critical for preventing and treating OBJECTIVE: To analyze the bacteriological characteristics in the patients with periprosthetic joint infection following TKA, so as to provide reference for early prevention and treatment. METHODS: CNKI, VIP, WanFang and PubMed databases were retrieved for the literature concerning periprosthetic infection following TKA published before 2016. The incidence of periprosthetic joint infection after TKA was statistically analyzed. RESULTS AND CONCLUSION: (1) 103 articles were included, involving 1 399 patients. (2) The main pathogenic bacteria were Staphylococcus aureus,coagulase negative Staphylococcus aureus,Staphylococcus epidermidis,Escherichia coli, Streptococcus and Enterococcus.There is no significant difference in the distribution of bacteria at home and abroad. Treatment strategies are divided into conservative and surgical treatments. (3) The key for successfully preventing and treating periprosthetic infection after TKA lies in the multiple disciplinary team collaboration, understanding the distribution of bacteria, early diagnosis and active preventive measurements, as well as rational treatment strategies.

Comparisons on chemical constituents of crude and wine-processed Dipsacus asper by using UPLC-Q-TOF/MS / 中国中药杂志

To compare the quality control indexes and chemical constituents of crude and wine-processed Dipsacus asper. According to Chinese Pharmacopoeia 2015 edition, water content, total ash, acid-insoluble ash and water soluble extract of different processed products were detected. UPLC-Q-TOF/MS approach was established to compare the contents of major constituents in crude and wine-processed D. asper. Moreover, the linearity, precision, stability, repeatability and recoveries of the approach were well studied. The results of water content, total ash, acid-insoluble ash and water-soluble extract of crude and wine-processed D. asper were all in line with the requirements of the Chinese Pharmacopoeia 2015 edition. Meanwhile, 20 main chemical constituents were identified by using UPLC-Q-TOF/MS. After wine-processing, the contents of asperosaponin Ⅵ, acetylate analogues and caffeic acid were significantly increased, while the contents of other phenolic components such as dicaffeoylquinic acid were decreased significantly, which may be which may be the main reason for different clinical efficacy of crude and wine-processed D. asper.

Role of inhibition of osteogenesis function by Sema4D/Plexin-B1 signaling pathway in skeletal fluorosis in vitro / 华中科技大学学报（医学）（英德文版）

Skeletal fluorosis is a chronically metabolic bone disease with extensive hyperostosis osteosclerosis caused by long time exposure to fluoride. Skeletal fluorosis brings about a series of abnormal changes of the extremity, such as joint pain, joint stiffness, bone deformity, etc. Differentiation and maturation of osteoblasts were regulated by osteoclasts via Sema4D/Plexin-B1 signaling pathway. Furthermore, the differentiation and maturation of osteoclasts are conducted by osteoblasts via RANKL/RANK/OPG pathway. Both of these processes form a feedback circuit which is a key link in skeletal fluorosis. In this study, an osteoblast-osteoclast co-culture model in vitro was developed to illustrate the mechanism of skeletal fluorosis. With the increase of fluoride concentration, the expression level of Sema4D was decreased and TGF-β1 was increased continuously. OPG/RANKL mRNA level, however, increased gradually. On the basis of that, the inhibition of Sema4D/Plexin-B1/RhoA/ROCK signaling pathway caused by fluoride promoted the level of TGF-β1 and activated the proliferation of osteoblasts. In addition, osteroprotegerin (OPG) secreted by osteoblasts was up-regulated by fluoride. The competitive combination of OPG and RANKL was strengthened and the combination of RANKL and RANK was hindered. And then the differentiation and maturation of osteoclasts were inhibited, and bone absorption was weakened, leading to skeletal fluorosis.

Correlation analysis between imaging features and lymph node metastasis in T1a lung adenocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the data of patients with clinical stage T1a lung adenocarcinoma and find the predictive factors associated with lymph node metastasis.</p><p><b>METHODS</b>From January to June 2012, 271 patients with small nodules of peripheral lung adenocarcinoma were enrolled in the retrospective review. There were 105 male and 112 female patients, with an average age of (61 ± 11)years (range 32-85 years). The data were collected including age, gender, smoking history, carcinoembryonic antigen(CEA), imaging findings, surgical procedure, pleural involvement, symptoms, tumor size, pathological classification, pathologic stage, maximum standardized uptake value(SUVmax) and lymph node metastasis. The predictive factors of lymph node metastasis in clinical factors were detected by univariate and multivariate analysis.</p><p><b>RESULTS</b>By preoperative thin-section CT, 35 patients were categorized as pure ground-grass opacity(GGO), 11 cases of atypical adenomatous hyperplasia, 24 cases of adenocarcinoma in situ, with no lymph node metastasis. Categorized as mixed ground-glass opacities in 89 patients, 84 patients (94.4%) had no lymph node metastasis, only 5 patients (6.0%) with lymph node metastasis. Categorized as solid nodules in 93 patients, a total of 28 cases (30.1%) had lymph node metastasis. There were statistically significant difference between three groups (χ(2) = 23.41, P < 0.001) . By univariate analysis, we found that the predictive factors of lymph node metastasis were as follows: tumor size > 1 cm (χ(2) = 9.021, P < 0.003) , imaging performance with mixed GGO or solid nodules (χ(2) = 23.41, P < 0.000) , CEA > 5 µg/L (χ(2) = 15.541, P < 0.000) and PET-CT SUVmax > 5 (χ(2) = 0.644, P < 0.000). By multivariate analysis, we found that imaging performance (mixed GGO or solid nodules) was the independent predictor of lymph node metastasis in clinical factors (OR = 166.116, 95%CI:18.161-25.19, P < 0.001) .</p><p><b>CONCLUSIONS</b>Patients of pure GGO generally do not have lymph node metastasis. Tumor diameter > 1 cm, imaging findings with the mixed GGO or solid nodules, carcinoembryonic antigen CEA > 5 µg/L, PET-CT SUVmax > 5 are predictive factors of lymph node metastasis in which imaging is independent predictor.</p>

Minimally invasive aortic valve replacement for isolated aortic valve disease: clinical analysis of 101 consecutive patients / 中华外科杂志

<p><b>OBJECTIVE</b>To review the results for minimally invasive aortic valve replacement (AVR) through a 5 cm right anterolateral thoracotomy.</p><p><b>METHODS</b>From July 2009 to September 2011, 101 consecutive patients with isolated aortic valve disease (degenerative in 37 patients, rheumatic in 21 patients, congenital in 37 patients, endocarditic in 3 patients and aorta-arteritis in 1 patients) underwent AVR through the right anterolateral thoracotomy approach in the third intercostal space with a groin incision for femoral connection of cardiopulmonary bypass. The mean age was 45.7 years (ranging from 17 to 71 years). Sixty patients were male.</p><p><b>RESULTS</b>Operations were successfully performed in all but 1 patient (1.0%) who required intraoperative conversion to full sternotomy. Mean duration of cardiopulmonary bypass time and aortic cross-clamp time was (88 ± 24) minutes and (55 ± 18) minutes, respectively. Thirty-day mortality was 1.0% (1/101), this patient was found difficult in weaning off cardiopulmonary bypass and exhibited severe coronary artery plaque, although bypass graft was carried out immediately, the patient died of severe low cardiac output syndrome finally. No blood products were needed in 83.2% patients. Follow-up was performed in all patients at an average of (16 ± 7) months postoperatively. A good recovery was obtained in all patients except one who died of multiple organ failure caused by massive cerebral infarction 38 days after surgery.</p><p><b>CONCLUSIONS</b>Minimally invasive aortic valve replacement though the right anterolateral thoracotomy approach is safe and feasible, with good cosmetic results and rapid postoperative recovery. It is worthy of clinical elective application.</p>

The effects of genistein on transforming growth factor-β1-induced invasion and metastasis in human pancreatic cancer cell line Panc-1 in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreatic cancer is a devastating disease with the worst mortality rate. Therefore, a rational strategy for future drug development is critical. Genistein is a small, biologically active flavonoid that is found in high amounts in soy. This important compound supports a wide variety of biological activities, but is best known for its ability to inhibit cancer progression.</p><p><b>METHODS</b>Transwell chamber assay was performed to determine the effect of genistein on the invasion of the human pancreatic cancer cell line Panc-1 induced by transforming growth factor-β1 (TGF-b1) in the different condition (5 ng/ml 24 hours and 10 ng/ml 48 hours); Reverse transcription-polymerase chain reaction (RT-PCR) was used to estimate the mRNA levels of urinary plasminogen activator (uPA), matrix metallopeptidase 2/9 (MMP-2/9), Smad4, E-Cadherin and Vimentin; Western blotting was used to detect the protein levels of uPA, E-Cadherin, ERK1/2, P38 and P-P38, and the activity of MMP-2/9 protein were detected by gelatin zymography assay method. Cells structure was observed and analyzed by microscopy.</p><p><b>RESULTS</b>Genistein can inhibit effectively TGF-b1-induced invasion and metastasis in Panc-1 by Transwell assay, which is through regulating the mRNA and protein expression of uPA and MMP2, but not MMP9 by RT-PCR/Western blotting, and is positively correlated with the concentration of genistein. At the same time, genistein also could improve the progress of epithelial-mesenchymal transition (EMT) via morphology observation using light microscopy/transmission electron microscopy (TEM), which is mediated by the down-regulation of E-cadherin and the up-regulation of vimentin.</p><p><b>CONCLUSIONS</b>TGF-b1 mediates EMT process via numerous intracellular signal transduction pathways. The potential molecular mechanisms are all or partly through Smad4-dependent and -independent pathways (p38 MAPK) to regulate the antitumor effect of genistein.</p>

Evidence of "who knows acupuncture believes the importance of the pressing hand" in ancient literatures and its clinical significance / 中国针灸

According to the records in ancient Chinese literatures such as Lingshu (Miraculous Pivot), Nanjing (The Yellow Emperor's Canon of 81 Difficult Issues), Jinzhen fu (Odes to Golden Needles) and Zhenjiu Dacheng (Compendium of Acupuncture and Moxibustion), the importance of pressing hand has been always stressed. The role of the pressing hand can irreplaceable by the puncturing hand. The touching and pressing with the pressing hand assist on the accurate location of acupoint. The plucking technique may invigorate meridian qi and promote the arrival of qi. Inserting the needle against the finger nail of the pressing hand avoids or alleviates pain to the largest extent. Detecting along meridian and pressing technique main induce qi getting to the affected area. This paper introduces the importance of pressing hand, aiming to suggest the clinical physicians pay more attentions to the effect of the pressing hand in acupuncture practice.

Repair of posterior mitral valve prolapsed: comparative study of three different approaches / 中华外科杂志

<p><b>OBJECTIVE</b>To compared outcomes of robotic mitral valve repair with those of standard sternotomy, and right anterolateral thoracotomy.</p><p><b>METHOD</b>From August 2010 to July 2011, 70 patients with degenerative mitral valve disease and posterior leaflet prolapsed scheduled for elective isolated mitral valve repair were prospectively nonrandomized to undergo mitral valve operation by standard sternotomy (n = 30), right anterolateral thoracotomy (n = 30), or a robotic approach (n = 10). There were 49 male and 21 female patients, aging from 16 to 70 years with a mean of 53.4 years. Outcomes of the three groups were compared.</p><p><b>RESULTS</b>Mitral valve repair was achieved in all patients except 1 patient in the standard group. There were no in-hospital deaths. The median operation time [(300 ± 41) min, (184 ± 20) min and (169 ± 22) min, F = 112.5, P < 0.01], cardiopulmonary bypass time [(139 ± 26) min, (82 ± 20) min and (69 ± 23) min, F = 36.8, P < 0.01], aortic cross-clamping time [(93 ± 23) min, (47 ± 10) min and (38 ± 8) min, F = 75.0, P < 0.01] were longer for robotic than standard sternotomy and right anterolateral thoracotomy. The robotic group had shortest time of mechanical ventilation time [(4.9 ± 2.1) h, (5.3 ± 4.5) h and (14.1 ± 10.2) h, F = 13.2, P < 0.01], ICU time [(15.1 ± 2.1) h, (16.4 ± 5.4) h and (28.7 ± 16.1) h, F = 11.6, P < 0.01], postoperative hospital stay time [(4.6 ± 1.0) d, (5.7 ± 1.7) d and (8.8 ± 5.1) d, F = 8.0, P < 0.01] with the lowest of drainage [(192 ± 200) ml, (215 ± 163) ml and (405 ± 239) ml, F = 7.1, P < 0.01] and ratio of the patients needed blood transfusion (0, 20.0% and 66.7%, χ(2) = 22.7, P < 0.01). Patients were followed up 6 to 17 months, with 100% completed. No patients died during follow-ups, and no moderate or more mitral regurgitation was observed. The robotic group had the shortest time of return to normal activities compared with the other two groups [(2.4 ± 0.7) weeks, (4.2 ± 1.2) weeks and (8.2 ± 1.8) weeks, F = 83.0, P < 0.01].</p><p><b>CONCLUSION</b>This study shows mitral valve repair via the right anterolateral thoracotomy and a robotic approach is safe and feasible, with good cosmetic results and rapid postoperative recovery, and is worthy of clinical selective application.</p>