Synthesis and antibacterial activity evaluation of octapeptin derivatives / 药学学报

Octapeptin has strong antibacterial activity against Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii, while it also has activity against some Gram-positive bacteria. This study used natural octapeptin A3 and B3 as lead compounds for structural modification. Twenty-one peptide derivatives (including A3 and B3) containing eight amino acid residues were prepared by solid-phase synthesis, and evaluated for antibacterial activity and renal cytotoxicity. Among them, three compounds 6, 7 and 17 exhibited broad-spectrum antibacterial activity and significantly enhanced the activity for Gram-positive bacteria while maintaining the activity of Gram-negative bacteria. Several compounds improved the activity for Pseudomonas aeruginosa. Compound 7 was active against all test strains and had relatively low renal cytotoxicity. The results provide a basis for the further development of novel polypeptide antibiotics.

Efficacy of implantable collamer lens V4c implantation in the treatment of high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the effect of implantable collamer lens V4c(ICL V4c)implantation on high myopia, and the changes in anterior segment morphology.METHODS:A prospective study was conducted on 100 patients(200 eyes)with high myopia who were treated with ICL V4c implantation in the hospital from February 2018 to March 2021. The best corrected visual acuity(BCVA), uncorrected visual acuity(UCVA), intraocular pressure, higher-order aberration, anterior segment morphology [iridocorneal angle(ICA), central anterior chamber depth(ACD), anterior chamber volume(ACV), central corneal thickness(CCT)and K-value(K)], photopic and scotopic contrast sensitivity before operation and 6 and 12mo after operation were comparatively analyzed.RESULTS:All patients were followed-up. UCVA and BCVA were significantly improved at 6 and 12mo after operation(P<0.05). Total higher-order aberration, horizontal coma and vertical coma showed no significant difference before and after operation(P>0.05). Spherical aberration, ICA, ACD and ACV at 6 and 12mo after operation were significantly smaller than those before operation(P<0.05). Under photopic state, the contrast sensitivity of 3.0 and 6.0 c/d was significantly higher at 6 and 12mo after operation when compared with that before operation(P<0.05). Under scotopic state, the contrast sensitivity of 6.0 c/d was significantly higher at 6 and 12mo after operation when compared with that before operation(P<0.05); there was no significant difference in CCT, K, or intraocular pressure before and after operation(P>0.05).CONCLUSION:Although ICA, ACD and ACV in patients with high myopia are reduced after ICL V4c implantation, the operation can effectively improve visual acuity and visual quality.

Development and application syndromic surveillance and early warning system in border area in Yunnan Province / 中华流行病学杂志

Objective: To establish a dynamic syndromic surveillance system in the border areas of Yunnan Province based on information technology, evaluate its effectiveness and timeliness in the response to common communicable disease epidemics and improve the communicable disease prevention and control in border areas. Methods: Three border counties were selected for full coverage as study areas, and dynamic surveillance for 14 symptoms and 6 syndromes were conducted in medical institutions, the daily collection of information about students' school absence in primary schools and febrile illness in inbound people at border ports were conducted in these counties from January 2016 to February 2018 to establish an early warning system based on mobile phone and computer platform for a field experimental study. Results: With syndromes of rash, influenza-like illness and the numbers of primary school absence, the most common communicable disease events, such as hand foot and mouth disease, influenza and chickenpox, can be identified 1-5 days in advance by using EARS-3C and Kulldorff time-space scanning models with high sensitivity and specificity. The system is easy to use with strong security and feasibility. All the information and the warning alerts are released in the form of interactive charts and visual maps, which can facilitate the timely response. Conclusions: This system is highly effective and easy to operate in the detection of possible outbreaks of common communicable diseases in border areas in real time, so the timely and effective intervention can be conducted to reduce the risk of local and cross-border communicable disease outbreaks. It has practical application value.

Changes of choroidal structure in children with hyperopic amblyopia observed by EDI-OCT technique / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the differences in choroidal structure between hyperopic amblyopia and normal children of the same age by the enhanced depth imaging optical coherence tomography(EDI-OCT)technique.METHODS: There were 35 cases in 50 eyes of children with hyperopic amblyopia visiting our hospital in January 2021 to December 2021 selected in the amblyopic group, and 30 cases in 51 eyes of healthy children who matched general data in the same period were selected in the control group. EDI-OCT examination was performed to measure the choroidal thickness(CT). After image processing, the total choroidal area(TCA), luminal area(LA), stromal area(SA)and choroidal vascularity index(CVI)were obtained.RESULTS: TCA(except inferior quadrant), SA(except inferior quadrant of the outer ring), LA and CT(except inferior and temporal quadrant )in the amblyopic group of each area were significantly larger than that in the control group(P<0.05), and there was no significant difference in CVI between the two groups except the temporal quadrant of the outer ring(P>0.05). There was no significant difference in CT for all degrees of hyperopic amblyopia, with the exception of the nasal quadrant(P>0.05).CONCLUSION: Hyperopic amblyopia is accompanied with abnormal choroidal structure. As the degree of hyperopia increases, TCA, LA and SA exhibit increasing trends. The changes in choroidal structure are presumed to be related to hyperopic amblyopia.

Effects of the psychological aggression and corporal punishment college students experienced before the age of 10 on anxiety and health related risky behaviors / 中国学校卫生

Objective@#To provide a basis for college students mental health education and guidance, the impact of psychological aggression and corporal punishment college students experienced before the age of 10 on anxiety and health risk behaviors was explored.@*Methods@#In April and May 2019, the convenience sampling method was used to conduct a questionnaire survey among all the freshman and sophomore students of some majors in two universities in Harbin, including a total of 2 150 students. The contents of the questionnaire included general information survey, Parent-Child Conflict Tactics Scale (CTSPC)，Self-Rating Anxiety Scale (SAS) and Adolescent Health related Risky Behavior Inventory (AHRBI).@*Results@#The percentage of college students who suffered psychological aggression and corporal punishment before the age of 10 was 80.05% and 58.37%. The detection rate of corporal punishment in boys and non-only child was significantly higher than that in girls and only child (P<0.05). The students who experienced psychological aggression and corporal punishment before the age of 10 had higher detection rates of anxiety state and six subscales of health risk behaviors than those who didn t experienced those (P<0.05). The Logistic regression analysis showed that, psychological aggression, place of residence, corporal punishment, and only child were positively associated with college students anxiety state (OR=1.85,1.53,1.49,1.34). The Logistic regression analysis showed that, psychological aggression, place of residence were positively associated with college students health-compromising behaviors (OR=1.60,1.26). Psychological aggression, gender factors, corporal punishment, and only child all influenced college students aggression and violence behavior (OR=1.75,1.66,1.63,1.28). Corporal punishment influenced college students suicide and self-injury behavior (OR=3.44). Gender factors and corporal punishment all influenced college students smoking and drinking behavior (OR=2.67,2.25).Corporal punishment and psychological aggression were positively associated with college students rule breaking behavior (OR=1.88,1.55). Corporal punishment, gender factors, and family income all influenced college students unprotected sexual behavior (OR=4.51,1.91,0.62).@*Conclusion@#Parental psychological aggression and corporal punishment college students experienced during childhood have a negative impact on their anxiety and health risk behaviors.

Structure modification and antimicrobial activity of novel cationic melittin analogues / 药学学报

Melittin exhibits high antibacterial potency against drug-resistant bacteria. However, the clinical utility of melittin is limited by its serious hemolytic activity. Thus, the need for developing novel melittin analogues with high antimicrobial activity and low hemolytic activity has grown. We designed, synthesized, and evaluated 20 novel melittin analogues with varying hydrophobic, polar or positively charged amino acids. The results showed that 8 compounds had antimicrobial activity (MIC: 1-4 μg·mL-1) against gram-positive pathogens equal to or better than that of melittin, and 16 compounds had low hemolytic activity (HC50 ≥ 11.9 μg·mL-1). Compounds 13 (MIC: 2-4 μg·mL-1) and 15 (MIC: 1-2 μg·mL-1) showed equal or better antimicrobial activity against both susceptible and resistant strains of Staphylococcus aureus and Enterococcus faecium compared to melittin (MIC: 4 μg·mL-1). Compound 13 (HC50: 24.0 ± 4.3 μg·mL-1) displayed noticeably decreased hemolytic activity compared to melittin (HC50: 5.3 ± 0.4 μg·mL-1). This work established a base for further study on the structure-activity relationships and structure-toxicity relationships of melittin.

Risk Factors of Colorectal Stricture Associated with Developing High-Grade Dysplasia or Cancer in Ulcerative Colitis: A Multicenter Long-term Follow-up Study

Background/Aims@#The risk factors of colorectal stricture associated with ulcerative colitis (UC) carcinogenesis in the long-term disease duration remain unclear. @*Methods@#This study included all UC patients registered from a prospectively maintained database between June 1986 to July 2018. The demographic data, clinical features, and outcomes in patients with dysplasia and stricture were assessed using univariable analysis and multivariate logistic regression models. @*Results@#A total of 246 eligible patients were in-cluded in the analysis. The median follow-up time was 13.0 years (interquartile range [IQR], 9.0 to 16.0). There were 35 cases (14.2%) of colorectal stricture. Patients with stricture had worse clinical outcomes. Stricture formation (odds ratio [OR], 9.350; 95% confidence interval [CI], 2.842 to 30.762), inflammatory polyps (OR, 5.464; 95% CI, 1.692 to 17.638), disease duration of more than 10 years (OR, 3.223; 95% CI, 1.040 to 9.985), and age >40 years at diagnosis (OR, 8.499; 95% CI, 1.903 to 37.956) were significantly associated with high-grade dysplasia or colorectal cancer. In addition, disease duration of more than 5 years (OR, 3.211; 95% CI, 1.168 to 8.881), moderated anemia (OR, 3.373; 95% CI, 1.472 to 7.731), and primary sclerosing cholangitis (OR, 5,842; 95% CI, 1.395 to 24.468) were contributing factors for the development of colorectal stricture. @*Conclusions@#Colorectal stricture had the highest risk for malignant transformation.Earlier initiation of colonoscopic surveillance in UC patients with risk factors for stricture should be considered to prevent stricture formation and further malignant transformation.

Comparative study on the life satisfaction and social desirability of only and non-only children in urban and rural areas of Harbin / 中国学校卫生

Objective@#To compare life satisfaction and social desirability between only and non-only children in urban and rural areas, and to provide a basis for future mental health education guidance.@*Methods@#Stratified cluster sampling method was used to select 3 765 students of grade 4 and 5 from 9 primary schools in urban and rural area of Harbin. The contents of the questionnaires included general information survey, the Multidimensional Student’s Life Satisfaction Scale (MSLSS) and the Children’s Social Desirability Scale (CSD).@*Results@#In the overall life satisfaction, county children had the highest satisfaction (5.10±0.50), while rural children had the lowest satisfaction (4.96±0.57);The life satisfaction of girls was higher than that of boys; The life satisfaction of only children was higher than that of non-only children(F/t=17.04,-5.91,2.21,P<0.05). In terms of social desirability, the social desirability of urban children(32.33±7.04) and county children (31.78±6.30) was higher than that of rural children(30.82±6.34).The social desirability of girls was higher than that of boys, the only children was higher than that of the non-only children (P<0.05). In the overall life satisfaction and all domains of life satisfaction apart from friend life satisfaction, the life satisfaction of urban girls was higher than that of boys(P<0.05). Except for county non-only children, the social desirability of girls was higher than that of boys (P<0.05). In the overall life satisfaction and all domains of life satisfaction apart from family life satisfaction, the life satisfaction of county boys was highest among three areas (P<0.05). In all domains of life satisfaction, the life satisfaction of county girls was highest and the life satisfaction of rural girls was lowest(P<0.05). In the family life satisfaction, the life satisfaction of only boys in urban areas was higher than that of non-only boys(P=0.03). In the overall, friend, living environment and self-dimension life satisfaction, the only and non-only children in the urban, county and rural area had significant differences (P<0.05). In addition, the life satisfaction of county children was highest and the life satisfaction of rural children was lowest. The social desirability of only children in urban and county areas was higher than that of only children in rural areas.@*Conclusion@#There are differences in life satisfaction and social expectations among urban, county and rural children in Harbin. Corresponding intervention strategies should be developed when administers psychological counselling to children.

A review of the phytochemistry and pharmacological activities of Ephedra herb / 中国天然药物

Ephedra herb is a traditional Chinese medicine with a long history. Conventionally, it was used as a folk phytomedicine in many ancient medical books and traditional prescriptions. Up to date, a variety of specific ingredients have been found in Ephedra herb, mainly including alkaloids, flavonoids, tannins, polysaccharides, organic acids, volatile oils, and many other active compounds. These components from Ephedra herb account for its use as the accurate treatment of cold, cough, cardiovascular and immune system disease, cancer, microbial infection, and other diseases. Moreover, with the fast development of novel chemistry and medicine technology, new chemical constituents and pharmacological effects of Ephedra herb are increasingly identified, demonstrating their great potential for various diseases treatment. Therefore, further detailed understanding and investigation of this ancient herb will offer new opportunities to develop novel therapeutics. This study systematically reviews its progress of phytochemistry, traditional and modern pharmacology based on research data that have been reported, aiming at providing useful insight for commercial exploitation, further study and precision medication of Ephedra herb in future.

Management of choledocholithiasis during pregnancy by laparoscopic transcystic common bile duct stone extraction and cholecystectomy / 中华普通外科杂志

Objective To explore the feasibility and safety of laparoscopic transcystic common bile duct stone extraction and cholecystectomy in pregnant patients with choledocholithiasis.Methods A retrospective analysis of 4 pregnant patients with choledocholithiasis was performed.The clinicoradiologic,perioperative and follow up data were analyzed.Results The 4 patients were admitted for acute cholangitis at their second trimester of pregnancy.Preoperative MRCP demonstrated that the diameter of the common bile duct stone was less than that of the cystic duct.Laparoscopic transcystic common bile duct stone extraction and cholecystectomy were successfully conducted.Plasma shock wave lithotripsy was applied in one patient with impacted gallstone,intraoperative cholangiography was conducted in one patient with suspected residual stone.There was not major post-op complications nor stone recurrence in the follow up postoperatively.They all delivered a healthy baby on the expected date of childbirth.Conclusions Simutaneously laparoscopic transcystic common bile duct stone extraction and cholecystectomy in pregnant patients with choledocholithiasis is feasible and safe.

Impact of school bullying victimization and social supports on anxiety symptoms among medical college students / 中国学校卫生

Objective@#To understand impacts of past experiences of school bullying victimization and social supports on anxiety symptoms of college students, and to provide basic data for appropriate mental health education.@*Methods@#By using cluster random sampling method, a questionnaire survey was conducted among freshman, sophomore and junior college students majoring in clinical medicine from one medical university in Heilongjiang Province. The questionnaire included general demographic information, school bullying and self-rating anxiety scale.@*Results@#In this survey, 647 students (28.4%) were reported of anxiety symptoms, including 462 (20.3%) with mild anxiety, 162 (7.1%) with moderate anxiety, and 23(1.0%) with severe anxiety. Reported rate of mild, moderate and severe anxiety among college students with bullying victimization experiences during primary school students was 22.8%,33.9% and 59.6%, respectively (χ2=93.05, P<0.05). The figure among students with bullying victimization during junior school was 21.5%, 45.2% and 57.3%, respectively (χ2=186.79, P<0.05). Among those with bullying victimization experiences, anxiety symptoms showed no differences between students with or without social supports from peers, parents and teachers (χ2=7.95, P=0.54; χ2=11.57, P=0.24). Ordinal logistic regression showed bullying victimization during primary school and affection to primary school positively associated with anxiety symptoms among college students, while bullying victimization experiences during junior school showed no association with anxiety symptoms in college.@*Conclusion@#Bullying victimization experiences during primary school shows significant association with anxiety symptoms among college students.

Behavioral and emotional health and associated factors among first-born children in Harbin / 中国学校卫生

Objective@#To compare behavioral and emotional health among first-born children and the only-child in Harbin, as well as associated factors including parents, family background, parenting and family environment.@*Methods@#A questionnaire survey was conducted for 156 parents of first-born children and the only-children, matched in age (<3 months), class and gender. Achenbach Child behavior scale (CBCL), the Self-evaluation of Anxiety Scale (SAS), the Self-rating Depression Scale(SDS), the Parents Rearing Behavior Questionnaire (CRPR) and the Family Assessment Device Scale (FAD) were used.@*Results@#There was no statistically significant difference in the scores of each dimension of children's emotional and behavioral health between the two groups(17.88±5.93)(19.13±6.01),total score(t=-0.74，P>0.05). There was no statistical difference in anxiety and depression between the two groups of parents(χ2=0.51，0.40，P>0.05); In terms of parenting style, the acceptance and encouragement achievement score for first-born children was significantly higher than that of the only child (t=2.10,2.12, P<0.05). In terms of family functions, there was no statistical difference in total function (t=-0.43, P>0.05). Behavioral problems associated with parents' anxiety, depression, parental rearing style and family function. Regression analysis showed that behavioral problems were mainly affected by sibling relationship for first-born children(B=8.74) and family role function for the only child (B=1.27).@*Conclusion@#No significant differences in behavioral and emotional health between first-born child and the only child are observed. However, harmonious sibling relationship, emotionally supportive parents and home environment could help improving behavioral and emotional health.

Professional Reasoning of Occupational Therapy in China 1986-2006: A Documentary Analysis (Ⅰ) / 中国康复理论与实践

Objective:To understand the development of professional reasoning of occupational therapy (OT) in China from 1986 to 2006. Methods:A search of all OT papers published from 1986 to 2006 in the Chinese Academic Journals database yielded 1,308 papers. Among them, 52 papers were selected for further analysis of professional reasoning. Each was reviewed by three researchers. Thematic analysis was conducted using an interpretive approach. Results:Two themes were identified: ongoing changes and sustaining contexts. Theme one consisted of three changes: from OT being an approach used by various healthcare providers to becoming a separate profession; from simple and superficial (e.g., upper limb exercise) to in-depth and complex professional reasoning (e.g., occupation-based models); and from relying on overseas experience to building on local practice experience. Theme two covered three sustaining practice contexts: insufficient supply of qualified OT, misconceptions of the roles and functions of OT and scope confined to hospital-based rehabilitation for people with physical disability. Conclusion:This paper reported the historical development of professional reasoning in China from 1986 to 2006. Professional issues in early days have continued to influence current practice. We need to work together to sustain the spirit of OT and improve OT professional reasoning in China.

Design, synthesis, and biological evaluation of novel polymyxin B analogues / 药学学报

Polymyxin B and polymyxin E (colistin) are increasingly used as last-resort drugs for treatment of infections caused by multidrug-resistant gram-negative pathogens. Unfortunately, the application was limited due to the serious side effects, especially nephrotoxicity. Very recently, the need for developing more tolerated and more effective polymyxin analogues has grown. This study details the design, synthesis, and evaluation of two classes of polymyxin B analogues with varying hydrophobicity and bulkiness at the N-terminal fatty acyl chain or position 6 amino acid. 20 polymyxin B analogues were synthesized and the chemical structures of the analogues were confirmed by HR-MS and 1H NMR spectra. Compounds 7e (MIC: 0.5-4 μg·mL-1) and 7l (MIC: 0.25-2 μg·mL-1) showed similar or better antimicrobial activity against both susceptible and resistant strains of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa compared to polymyxin B (MIC: 0.5-2 μg·mL-1). Besides, compound 7l (CC50: 217.1±13.2 μg·mL-1) displayed noticeably decreased renal cytotoxicity compared to polymyxin B (CC50: 120.3±6.0 μg·mL-1). This work establishes the base of further study on the structure-activity relationship of polymyxin B.

Predictive study on school absences due to illness with seasonal exponential smoothing method / 中华疾病控制杂志

Objective To establish a suitable exponential smoothing prediction model for school absentees due to illness, to discuss its application value for predicting school absences due to illness, and to provide a basis for early warning of absence due to illness. Methods Numbers of schools absences by year and month due to illness in 30 primary schools from November 2015 to June 2017 were collected from symptom monitoring system of border county, southern Yunnan and Simple seasonal model, Winters addition model and Winters multiplication model were used to build simulation. The data of July 2017 to December 2017 were used for model validation. The three models were overall compared and evaluated through indicator analysis, statistical analysis and residual diagram analysis. The best model was selected to predict school absences due to illness from January 2018 to March 2018. Results Simple seasonal model, Winters addition model and Winters multiplication model were used to fit the variation trend of number of school absences due to illness in time series. The root mean square error (RMSE) of three models were 445.11, 420.99 and 258.75; R2adj were 0.72, 0.72 and 0.77; R2 were 0.92, 0.93 and 0.98; P values of Ljung-Box Q were 0.54, 0.43 and 0.21. As for prediction method linear trend, Alpha were 0.999, 1.000 and 0.298. The average relative error between predicted value and actual value was 9.62%, 21.90% and 7.52%. Conclusion Winters multiplication model has practical value to predict school absence due to illness and provide scientific basis for early identification of abnormal signals.

The prevalence of five common chronic diseases and multi-morbidity and its relationship with socioeconomic position among rural older adults in Yunnan Province / 中华疾病控制杂志

Objective To analyze the relationship between socioeconomic position and prevalence of hypertension, diabetes, coronary heart disease, stroke, chronic obstructive pulmonary diseases (COPD) and multi-morbidity among older adults in rural Yunnan Province. Methods A total of 4 833 older adults aged 60 years and over were selected by multi-stage stratified random sampling method in rural Yunnan Province. Information was acquired from questionnaire and health examination. Principal component analysis was used to construct the socioeconomic comprehensive score. Results The prevalence of hypertension, diabetes, stroke, coronary heart disease, COPD and multi-morbidity in target persons was 50.6%, 10.2%, 6.4%, 5.5%, 5.4% and 16.1% respectively. The prevalence of hypertension and diabetes was much higher in female compared with male (both P<0.05), in contrast the prevalence of COPD was much higher in male than female( 2=5.499, P=0.019)The prevalence of hypertension, stroke, coronary heart disease, COPD and multi-morbidity was increased with age(all P<0.05);Minority ethnic were more likely to develop hypertension, coronary heart disease, COPD and multi-morbidity than Han ethnic(all P<0.05). The results of multivariate logistic regression analysis showed that older adults with lower socioeconomic position had higher probability of suffering from hypertension, coronary heart disease, stroke, COPD and multi-morbidity (all P<0.05). Conclusions There are significant socioeconomic differences between socioeconomic position and prevalence of five major chronic diseases and multi-morbidity among older adults in rural Yunnan province. Older adults with low socioeconomic position should be key population for future prevention and control of chronic diseases.

Study on sleep quality status and its relationship with cardiovascular disease in rural elderly in Ning’er county, Yunnan province / 中华疾病控制杂志

Objective To analyze the sleep quality status and its relationship with cardiovascular disease in rural elderly in Yunnan Province. Methods Multistage stratified random sampling method was used to select 1629 residents aged 60 years and over from Ning Er County in Yunnan province. Each participant received questionnaire survey and physical examination. Multivariate logistic regression analysis was used to analyze the relationship between sleep quality status and cardiovascular disease. Results Among the study population, the overall Pittsburgh Sleep Quality Index (PSQI) score was 7.48±3.89,and was 6.67±3.69 for males and 8.07±3.92 for females. The prevalence of sleep disorder, hypertension, coronary heart disease and stroke were 56.78%, 52.85%, 8.16% and 8.66%, respectively. Females had higher prevalence of sleep disorder than males (62.81% and 48.55%，P<0.001). The elderly with lower annual average family per capital income and bad access to medical services had higher prevalence of sleep disorder than their counterparts (P<0.001).The elderly with sleep disorder was more likely to suffer from hypertension, coronary heart disease and stroke (P<0.05). Conclusion The prevalence of sleep disorder is high in rural elderly in Yunnan Province. Improving sleep quality among the elderly can prevent and control cardiovascular diseases to a certain degree.

Comparison of the minimally invasive treatments of laparoscopic and endosopic for common bile duct stones after gastrojejunostomy / 北京大学学报(医学版)

OBJECTIVE@#To explore the feasibility and to compare the merits and demerits of laparoscopic and endoscopic approach in removing common bile duct stones in patients with gastrojejunostomy after gastrectomy.@*METHODS@#Between January 2012 and December 2016, 25 patients with common bile duct stones after gastrojejunostomy received laparoscopic or endoscopic treatment in our centers. They were divided into laparoscopic group and endoscopic group based on treatment approaches for common bile duct stones, including 15 patients in laparoscopic group and 10 in endoscopic group. The clinical characteristics and outcomes between the two groups were retrospectively analyzed.@*RESULTS@#Among the 25 patients with gastrojejunostomy, the method of reconstruction was Billroth II in 21 patients and Roux-en-Y in 4 patients. Six patients received laparoscopic or endoscopic treatment during the acute cholangitis state. Among the laparoscopic group, 5 patients with stones more than 1 cm, 7 patients with multiple stones, while in the endoscopic group, 3 patients with stones more than 1 cm and 4 patients with multiple stones. Fourteen patients in the laparoscopic group with coexisting gallbladder stones, and 6 of their common bile duct stones were successfully removed by transcystic approach without T tube drainage. Stone removals were successful in 4 patients of the endoscopic group by a single performance, including 3 patients with single small stone and one patient with multiple small stones. Two patients in the laparoscopic group were converted to open surgery for severe adhesion and one patient in the endoscopic group turned to laparoscopic operation for failing of finding papilla in the Roux-en-Y anastomotic status. The median hospital stays were 12 d and 10 d, respectively in the laparoscopic and endoscopic group. There were 3 patients with postoperative complications, including one patient with paralytic ileus in the laparoscopic group and 2 patients with biliary pancreatitis or bacteremia in the endoscopic group, and all of them recovered uneventfully with conservative treatment.@*CONCLUSION@#Both laparoscopic and endoscopic approaches are feasible for removing stones in the common bile duct in patients with gastrojejunostomy after gastrectomy, and they complement each other. In addition, both techniques are difficult to conduct, and a technical competence should be considered in selection of each method.

Prognostic factors of patients with unresectable liver metastasis from colorectal cancer after failed conversion chemotherapy / 中华胃肠外科杂志

OBJECTIVE@#To explore the prognostic factors of patients with unresectable liver metastasis colorectal cancer after failed conversion chemotherapy.@*METHODS@#A retrospective, case-controlled study was performed. Study subjects were 105 patients who were diagnosed with synchronous liver metastasis colorectal cancer after failed chemotherapy (metastasis evaluated as unresectable after the conversion chemotherapy) at Xinhua Hospital, Shanghai Jiaotong University from January 2012 to December 2015. Overall survival(OS) was retrospectively analyzed using Kaplan-Meier method. Log-rank test was used to compare survival among groups. Univariate and multivariate analysis was conducted for prognosis using Cox regression model.@*RESULTS@#Of 105 cases,70 were male and 35 were female with median age of 60 years old. Twenty-one patients had right colon cancer, 41 had left colon cancer, 42 had rectal cancer and 1 had synchronous cancers(sigmoid colon and rectum). One hundred and two (97.1%) patients were cT3-4 and 90 patients were cN+ (imaging diagnosis). Eighty-nine (84.8%) patients were loaded with 2 or more liver metastases with the median maximum diameter of 48.3 mm. The patients were followed up for 3 to 43 months from the day of diagnosis. The median OS was 11 months (interquartile range, 8-18). The median OS of patients with cN0, cN1 and cN2 stage was 17, 13 and 10 months, respectively(P=0.026). The median OS of patients with single lesion, 2-3 lesions, 4-10 lesions and more than 10 lesions was 15, 15, 17 and 9 months, respectively (P=0.002). OS of patients with maximum diameter of liver metastatic lesion ≤ 50 mm, 51-100 mm and >100 mm was 15, 10 and 8 months, respectively(P=0.003). The median OS of patients with chemotherapy response of partial response (PR), stable disease (SD) and progressive disease (PD) was 17, 14 and 8 months, respectively(P<0.001). OS was 17 months in patients receiving second line chemotherapy and was 10 months in those without second line chemotherapy (P<0.001). OS in patients undergoing primary tumor resection was 13 month and in those without primary tumor resection was 9 months; the difference was not significant (P=0.060). Multivariate analysis showed that cN2(HR=2.115, 95%CI:1.089-4.109, P=0.027), the maximum diameter of liver metastatic lesion more than 100 mm (HR=3.112, 95%CI:1.455-6.657, P=0.003), chemotherapy response of PD (HR=4.435, 95%CI:2.506-7.533,P<0.001) and without second line chemotherapy(HR=4.432,95%CI:2.186-8.986, P=0.010) were independent prognostic factors.@*CONCLUSIONS@#For patients with unresectable liver metastasis from colorectal cancer after failed conversion chemotherapy, prognostic factors include cN2, the maximum diameter of liver metastatic lesion, chemotherapy response and second line chemotherapy. Whether the resection of primary tumor can prolong OS further study.

Differential pathway and gene expressions of endophytic Phialocephala fortinii inoculated on Rhodiola crenulata / 药学学报

The development and metabolism of medicinal plant is affected by many factors, among which the effect from endophytic fungi has been noticed recently and has become one of hot fields. In order to explore the effect of endophytic fungi on gene expression in R. crenulata, RNA-sequencing was used to find genes involved in metabolic pathways, and the differential genes were verified by real-time fluorescent quantitative PCR. The method of 2-△△Ct was used to analyze the relative expression levels of genes in related metabolic pathways, which was used to verify the result of transcriptomics sequencing. The results showed that the endophytic fungus, P. fortinii, could up-regulate the gene expression in lipid metabolic pathway of R. crenulata. In signal transduction pathway, the genes were influenced at different level but the gene expressions were significantly increased under control of Notch signaling pathway, which was 34 times of that in control. The gene expressions of environmental adaption pathway were up-regulated in R. crenulata after inoculation of P. fortinii. This study could provide help for further understanding on mechanism of plant-fungus interaction, root cause of geoherbalism of medicinal plant and exploring bio-function of endophytic fungi.