Research progress in ecological prevention of dental caries / 中华口腔医学杂志

Dental caries is one of the most common oral diseases around the world. Dental plaque attached to the surfaces of teeth is the main biological factor leading to caries. Although fluoride is still one of the most commonly used methods to prevent caries, with the change of epidemiological characteristics of caries and the update of the understanding of caries etiology, it is necessary to use other ecological methods such as antimicrobial peptides, arginine, probiotics and natural products, etc. to enhance the effect of fluoride in preventing dental caries. The present article reviews the research progress on the ecological approaches for caries prevention in recent years.

Review of the in vitro inhibitory effects of traditional Chinese medicine and its components on CYP450 enzymes in liver microsomes / 药学学报

Cytochrome P450s (CYP450) is a superfamily of phase I metabolic enzymes, which participates in more than 90% of drug oxidation. The induction or inhibition of CYP450s is the main mechanism of drug-drug interaction. In recent years, in vitro metabolism studies conducted through isolated organs, cells, or enzyme systems have developed rapidly, due to their precision and simplicity. Therefore, profiles of the in vitro metabolism studies of traditional Chinese medicines can infer the possible metabolic pathways of drugs, predict the potential drug interactions, and may enhance the rational use of drugs in clinic. This article reviews the in vitro inhibitory effects of traditional Chinese medicine, ingredients, and extracts on the activities of CYP450 enzymes in the liver microsomes, which can provide a reference for further researches on the interaction between Chinese medicine and chemical medicine.

Changes of pharmacokinetics and application of physiologically based pharmacokinetic modeling in pharmacotherapy during pregnancy / 药学学报

The rational medication in pregnant women is a clinical issue that clinicians and pharmacists must take seriously. Most tissues and organs undergo anatomical and physiological changes during pregnancy that affect the absorption, distribution, metabolism, and excretion of drugs in vivo, which ultimately lead to changes in bioavailability. In order to achieve an effective therapeutic concentration, dose adjustment might be required during this period. In the past ten years, the application of modeling and simulation methods in the field of drug development and clinical therapy has continued to expand, for instance, using population pharmacokinetic (PPK) and physiologically based pharmacokinetic (PBPK) modeling to adjust dosage regimen in special populations. Rigorously designed and validated models will effectively make up for the deficiencies of clinical trials, provide valuable references for the design of clinical research, and even replace part of them. This article will introduce the physiological changes that affect the pharmacokinetic properties of the drug during pregnancy and review the progress in the application of PBPK modeling in pharmacokinetic studies in pregnant women.

Altered dopamine metabolism and its role in pathogenesis of Parkinson's disease / 生理学报

Parkinson's disease (PD), one of the most frequent neurodegenerative disorders, is characterized by the selective loss of dopaminergic neurons in the substantia nigra (SN). Genetic vulnerability, aging, environmental insults are believed to contribute to the pathogenesis of PD. However, the cellular and molecular mechanism of dopaminergic neurons degeneration remains incompletely understood. Dopamine (DA) metabolism is a cardinal physiological process in dopaminergic neurons, which is closely related to the loss of dopaminergic neurons in the SN. DA metabolism takes part in several pathological processes of PD neurodegeneration, such as iron metabolism disturbance, α-synuclein mis-folding, endoplasmic reticulum stress, protein degradation dysfunction, neuroinflammatory response, etc. In this review, we will describe altered DA metabolism and its contributions to PD pathogenesis.

Effect of KLF-4 on peritoneal fibrosis induced by high glucose peritoneal dialysate via targeting regulation of the expression of E-cadherin / 解放军医学杂志

[Abstract] Objective To explore the relationship between Kruppel-like factor 4 (KLF-4) and E-cadherin in human peritoneal mesothelial cells (HPMCs), and the expression and function of KLF-4 in the animal model of peritoneal fibrosis induced by high glucose peritoneal dialysate. Methods Co-transfection in HPMCs with the plasmid of KLF-4 and the bind site or mutant in the promoter region of E-cadherin, and then the luciferase activity was measured of the each bind site and its matched mutants to estimate whether KLF-4 can combine with the bind site in the promoter region of E-cadherin; Chromatin immunocoprecipitation (CHIP) was exploited to verify if KLF-4 can combine with the bind site in the promoter region of E-cadherin; Real-time PCR and Western blotting were performed to detect the expression of E-cadherin at the bind site and matched mutants of b, d, f and g. Thirty SD rats were randomly divided into saline group, peritoneal dialysate group and experimental group (10 each). Rats in saline group were given intraperitoneal injection with 0.9% NaCl, in peritoneal dialysate group were given with 4.25% high glucose peritoneal dialysate, and in experimental group were given via tail vein with 4.25% high glucose peritoneal dialysate and the mixture of KLF-4 plasmid suspension containing ultrasound microbubble. To observe the peritoneal tissue thickness of the 3 groups of rats by Hematoxylin and Eosin staining. Masson trichrome staining was performed to detect the deposition of collagen fibers in peritoneal tissue of the 3 groups of rats. Immunohistochemistry was used to detect the expression level of KLF-4, E-cadherin, α-SMA and fibronectin (FN) in peritoneal tissue of the 3 groups of rats. Results Promoter luciferase reporter gene and CHIP results showed that KLF-4 can combine with the bind site in the promoter region of E-cadherin in HPMCs. Real-time PCR and Western blotting showed that KLF-4 can positively regulate the expression of E-cadherin. HE staining showed that the peritoneal tissue was obviously thickened in rats of peritoneal dialysate group [(105.91±12.0) μm] than in rats of saline group [(20.89±5.39) μm] and of experimental group [(23.05±6.07) μm] with statistical significance (P0.05). Masson staining showed that the deposition of collagen fiber significantly increased in peritoneal dialysate group (0.89±0.09) than in saline group (0.19±0.03) and experimental group (0.15±0.06) with statistical significance (P0.05). Immunohistochemistry results showed that the expressions of KLF-4 and E-cadherin were obviously lower in peritoneal dialysate group (0.27±0.09, 0.31±0.03) than in saline group (0.79±0.19, 0.83±0.13) and experimental group (0.85±0.11, 0.76±0.11) with statistically significant difference (P0.05). In contrast, the expressions of α-SMA and FN were evidently higher in peritoneal dialysate group (0.83±0.09, 0.63±0.09) than in saline group (0.22±0.08, 0.30±0.07) and experimental group (0.19±0.05, 0.11±0.03) with statistically significant difference (P0.05). Conclusion KLF-4 may positive regulate the expression of E-cadherin by combining with the bind site in the promoter region of E-cadherin, and inhibit the peritoneal fibrosis induced via high glucose peritoneal dialysate.

Effect of temperature maintenance by forced-air warming blankets of different temperatures on changes in inflammatory factors in children undergoing congenital hip dislocation surgery / 中华医学杂志(英文版)

BACKGROUND@#Hypothermia is associated with many adverse clinical outcomes in pediatric patients, and thus, it is important to find an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients. This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β (TGF-β), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip (DDH).@*METHODS@#The study included 123 children undergoing surgery for DDH under general anesthesia. The patients were randomly assigned to three groups, using a random number table: the 32, 38, and 43°C groups according to the temperature setting of the forced-air warming blankets. For each patient, body temperature was recorded immediately after anesthesia induction and intubation (T0), at initial incision (T1), at 1 h after incision (T2), at 2 h after incision (T3), at the end of surgery (T4), immediately upon return to the ward after surgery (T5), and then at 12 h (T6), 24 h (T7), 36 h (T8), and 48 h (T9) after the surgery. The serum levels of TGF-β, TNF-α, IL-1β, and IL-10 were measured at T0 and T4 for all groups.@*RESULTS@#The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups (χ = 6.630, P = 0.036). At T0, the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group (F = 17.992, P < 0.001). At T2, the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups (F = 12.776, P < 0.001). Moreover, at T4, the serum levels of TGF-β (F = 3286.548, P < 0.001) and IL-10 (F = 4628.983, P < 0.001) were significantly increased in the 38°C group, and the serum levels of TNF-α (F = 911.415, P < 0.001) and IL-1β (F = 322.191, P < 0.001) were significantly decreased in the 38°C group, compared with the levels in the 32 and 43°C groups.@*CONCLUSION@#Force-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.@*CLINICAL TRIAL REGISTRATION@#ChiCTR1800014820; http://www.chictr.org.cn/showproj.aspx?proj=25240.

Clinical characteristics of coronavirus disease 2019 patients complicated with liver injury / 中南大学学报(医学版)

OBJECTIVES@#To analyze the clinical characteristics in patients of coronavirus disease 2019 (COVID-19) complicated with liver injury, to explore the relationship between COVID-19 clinical classification and liver injury, and to elucidate whether COVID-19 complicated with hepatitis B virus can aggravate liver injury.@*METHODS@#The abnormal liver function in 110 patients in the First Hospital of Changsha, who were confirmed COVID-19 and admitted to the designated hospital from January 17, 2020 to February 20, 2020, wereretrospectively analyzed. The detection indexes included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBIL).@*RESULTS@#A total of 49.1% of the COVID-19 patients had liver injury. There were significant difference in the ALT, AST, ALB (all 0.05) between the severe (critical) patients and the general (light) patients. There was also no significant difference in the liver function injury between the HBsAg-positive COVID-19 patients and HBsAg-negative COVID-19 patients (>0.05). Acute liver injury was not found to be a direct cause of death in the patients.@*CONCLUSIONS@#In the COVID-19 patients, the incidence of liver injury is high with the increase of ALT and AST and the decrease of ALB. Severe and critical patients have obvious liver injury, and those patients complicated with hepatitis B virus infection don't show aggravated liver injury.

Apparent Diffusion Coefficient Histogram Analysis:Differentiation of Genetic Subtypes of Diffuse Lower-grade Gliomas / 中国医学科学院学报

To explore the utility of apparent diffusion coefficient(ADC)histogram analysis for differentiating genetic subtypes of diffuse lower-grade gliomas. A total of 55 patients with WHO grade Ⅱ/Ⅲ diffuse lower-grade gliomas who underwent preoperative routine brain magnetic resonance imaging and diffusion weighted imaging in our center were retrospectively evaluated.Among whom there were 14 patients with isocitrate dehydrogenase(IDH)wild-type gliomas(IDH group),19 patients with IDH-mutant 1p19q intact gliomas(IDH 1p19q group),and 22 patients with IDH-mutant 1p19q co-deleted gliomas(IDH 1p19q group).The whole-lesion ADC values derived from histogram analysis(including ADC,ADC,ADC5%,ADC10%,ADC25%,ADC50%,ADC75%,ADC90%,ADC95%,ADC,mode,range,skewness,kurtosis,standard deviation,inhomogeneity,and entrophy)were measured for each patient.All parameters between the different genetic subtypes were compared by using the Student's test or Mann-Whitney test.Receiver operating curve(ROC)analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the different genetic subtypes. Compared with IDH group,the ADC75%(=0.021),ADC90%(=0.015),ADC95%(=0.014),ADC (=0.035),range(=0.009),standard deviation(=0.001)and inhomogeneity(=0.001)were significantly lower in IDH group;in contrast,the ADC (=0.031)and kurtosis(=0.020)of IDH group were significantly higher than those in IDH group.The ADC(=0.010),ADC5%(=0.016),ADC10%(=0.012),ADC25%(=0.007),ADC50%(=0.005),ADC75%(=0.015),and mode(=0.002)were significantly higher in IDH 1p19q group than in IDH 1p19q group.Inhomogeneity achieved the highest area under ROC(AUC)(0.811)in differentiating IDH gliomas and IDH gliomas,with a cutoff value of 0.229;the sensitivity and specificity were 85.7% and 73.2%.The mode achieved the highest AUC(0.744)in differentiating IDH 1p19q gliomas and IDH 1p19q gliomas,with a cutoff value was 1448.75×10 mm /s;the sensitivity and specificity were 57.9% and 90.9%. ADC histograms analysis may be helpful to differentiate genetic subtypes in lower-grade gliomas.

Effect of Different Nitrogen Forms and Concentrations on Yield and Quality of Fritillaria thunbergii / 中国实验方剂学杂志

Objective:To investigate the effect of different nitrogen forms and concentrations on yield and quality in Fritillaria thunbergii，and provide basis for improving scientific utilization of nitrogenous fertilizer and its introduction to Chongqing area. Method:The pot culture experiment was conducted to investigate the changes in growth，physiological and biochemical characteristics，soil factors，alkaloid content and yield of Fritillaria thunbergii under the ratio of nitrate nitrogen（NO3--N） to ammonium nitrogen（NH4+-N）of 15∶0（N1），12∶3（N2），7.5∶7.5（N3），3∶12（N4） and 0∶15（N5）. Result:As compared with no-nitrogen（CK） treatment group，the growth and quality of F. thunbergii were significantly improved by different nitrogen nutrition treatments，with differences among them.With the increase of ammonium nitrogen concentration：①plant height and the activity of superoxide dismutase（SOD） reached the maximum when the ratio of NO3--N to NH4+-N was 3∶12，increased by 9.27% and 206.62% respectively compared with the CK group，② the length and width of leaf，stem diameter，chlorophyll a，chlorophyll b，total chlorophyll content，the content of available P and organic matter，total alkaloid content and yield reach the maximum when the ratio of NO3--N to NH4+-N was 0∶15，increased by 14.02%，16.44%，13.68%，40.75%，45.31%，41.72%，77.70%，14.70%，24.61%/47.39% respectively compared with the CK group，with the increase of nitrate nitrogen concentration，③the leaf index，soluble protein content，peimisine content/yield，yield of peiminine and dry weight of bulbs reached the maximum when the ratio of NO3--N to NH4+-N was 7.5∶7.5，increased by 2.54%，5.92%，21.76%/54.55%，60.61% and 26.93%，respectively compared with the CK group，④the content of carotenoids，pigment and peiminine，the activity of peroxidase（POD） and catalase（CAT），the content/yield of peimine，both peimine and peiminine，both peimine，peiminine and peimisine，dry weight of bulbs reached the maximum when the ratio of NO3--N to NH4+-N was 12∶3，increased by 45.39%，45.31%，36.01%，271.38%，67.45%，39.82%/64.87%，38.90%/63.80%，37.03%/61.57%，20.29% respectively compared with the CK group. Conclusion:All the results indicated that a higher proportion of NH4+-N is beneficial to the growth of F. thunbergii，while NO3--N is beneficial to the accumulation of alkaloids and the growth of bulbs.Therefore，the combined application of ammonium and nitrate（NO3--N to NH4+-N ratio of 12∶3） is more effective than pure nitrate or pure ammonium applications to improve the yield and quality of F. thunbergii．

Relationship of ADC histogram parameters with pathological grade and lymph node metastasis of prostate cancer / 中华男科学杂志

Objective@#To investigate the relationship between the apparent diffusion coefficient (ADC) histogram parameters based on the whole tumor and the pathological grade and lymph node metastasis (LNM) of PCa.@*METHODS@#This retrospective study included 82 cases of PCa confirmed pathologically and subjected to MRI preoperatively. We obtained a series of ADC histogram parameters, such as ADCmean, ADCmedian, ADC25%, ADC75%, entropy, and histogram width, by processing the ADC images via the Firevoxel Post-Processing and the SPSS24 software. We compared the parameters between the high-risk and low- or moderate-risk groups as well as between the LNM-positive and LNM-negative groups of the patients, and analyzed the diagnostic performance of the parameters with statistically significant differences.@*RESULTS@#The high-risk group, compared with the low- or moderate-risk one, showed a significantly lower ADCmean (［590 ± 120］ vs ［837 ± 142］ ×10－6 mm2/s, P < 0.01), ADCmedian (［560 ± 117］ vs ［804 ± 139］ ×10－6 mm2/s, P < 0.01), ADC25% (［446.5 ± 98］ vs ［717 ± 118］ ×10－6 mm2/, P < 0.01) and ADC75% (［667 ± 132］ vs ［931 ± 167］ ×10－6 mm2/s, P < 0.01). The ADCmean manifested the highest diagnostic performance, with an AUC of 0.907, a sensitivity of 0.933 and a specificity of 0.796. No statistically significant difference was found between the high-risk and the low- or moderate-risk one in entropy (3.58 ± 0.39 vs 3.63 ± 0.42, P = 0.238) or the histogram width (［540 ± 73］ vs ［520 ± 65］ ×10－6 mm2/s, P = 0.086). Both entropy and the histogram width were remarkably higher in the LNM-positive than in the LNM-negative group (3.95 ± 0.41 vs 3.12 ± 0.45, P < 0.01; ［578 ± 59］ vs ［455 ± 68］ ×10－6 mm2/s, P < 0.01), and the former had an even higher diagnostic performance, with an AUC of 0.836, a sensitivity of 0.887 and a specificity of 0.781. There were no statistically significant differences between the LNM-positive and LNM-negative groups in the ADCmean (［768 ± 135］ vs ［790±128］ ×10－6 mm2/s, P = 0.402), ADCmedian (［759 ± 110］ vs ［775 ± 121］ ×10－6 mm2/s, P = 0.225), ADC25% (［643 ± 91］ vs ［657 ± 89］ ×10－6 mm2/s, P = 0.654) or ADC75% (［895 ± 127］ vs ［872 ± 129］ ×10－6 mm2/s, P = 0.926).@*CONCLUSIONS@#ADC histogram parameters are related to pathological grade and LNM of PCa, and the analysis of the ADC histogram based on the whole tumor has an important value for preoperative evaluation and prognostic estimation of the malignancy.

Acquisition of multidrug resistance by overexpression of Twist1 in colorectal cancer cells SW620 and its mechanism / 中国免疫学杂志

Objective: To investigate the effect of overexpression of Twist1 on multidrug resistance( MDR) in colorectal cancer SW620 cells and its possible mechanism. Methods: The colorectal cancer SW620 cells were transfected with Twist1 overexpressing lentivirus and negative control virus, which were called experimental group ( SW620-Twist1) and control group ( SW620-NC) respectively. The protein and mRNA expression of Twist1、ABCB1 and ABCG2 in two groups were detected by Western blot and RT-qPCR, respectively. The growth inhibitory rate of 5-Fluorouracil(5-FU) and Oxaliplatin( OXA) at 24 ,48 and 72 h in two groups were determined by CCK8 assay. Cancer stem cell markers CD133,CD44 expression levels were detected by Flow cytometry. Results: The experimental group was compared with the control group, the expressions of Twsit1 gene mRNA and protein increased significantly( P<0. 01) ,Twist1 gene overexpressing SW620 cell line was successfully constructed. The inhibition rates of cell proliferation of the three chemotherapeutic drugs at 48 h and 72 h were significantly decreased ( 48 h, P<0. 05 ; 72 h, P<0. 01) . The mRNA and protein expression levels of ABCB1,ABCG2 were significantly increased( P<0. 01). The expression of CSCs markers CD133 and CD44 increased significantly (P<0. 01). Conclusion: Overexpression of Twist1 can promote the expression of ABCB1 and ABCG2 genes in SW620 cells and make the tumor cells acquire MDR. This phenomenon may be related to the promotion of stemness.

CT manifestations of hepatic lesions without obvious enhancement in arterial phase and their significancs in differential diagnosis / 吉林大学学报(医学版)

Objective:To study the CT findings of hepatic lesions without obvious enhancement in arterial phase, and to analyze the characteristics of the hepatic lesions.Methods:The clinical materials of 118cases of hepatic lesions without obvious enhancement in arterial phase scanned by enhanced CT were collected.The basic CT signs, characteristic CT signs and enhancement patterns were analyzed.Results:Among 118cases, there were 40hepatic metastases, 29liver abscesses, 21intrahepatic cholangiocelloma, 17hepatocellular carcinoma, 6inflammatory pseudotumor of liver and 5hepatic lymphoma;54cases showed single lesion and 64cases showed multiple lesions;24cases were sharp and 94cases were indistinct;41cases located in right hepatic lobe, 26cases located in left hepatic lobe, 50cases located in left and right hepatic lobe, and 1case located in hepatic caudate lobe.The diameters of lesions were 0.2-13.4cm.40cases of hepatic metastases showed mild marginal enhancement, while the incidence rate of bull eye sign was 12.50％ (5/40) ;29cases of liver abscess showed ring or honeycomb-like enhancement, while the incidence rates of double ring sign and gas bubbles were 13.79％ (4/29) and 13.79％ (4/29) .Seventeen cases of intrahepatic cholangiocelloma showed slow progressive enhancement, while the incidence rates of intrahepatic bile duct dilatation, hepatic capsular depression and calcification were 57.14％ (12/21) , 23.81％ (5/21) and 9.52％ (2/21) .Seventeen cases of hepatocellular carcinoma showed various enhancement patterns, while the incidence rates of liver contour change, hepatic artery enlargement and vessel invasion were 41.18％ (7/17) , 41.18％ (7/17) and 35.29％ (6/17) .Four cases of inflammatory pseudotumor of liver showed septal and nodular enhancement;5cases of hepatic lymphoma showed internal minimal homogeneous enhancement, while the incidence rate of'vascular floating'sign was 40.00％ (2/5) .Conclusion:Spiral CT examination of the hepatic lesions without obvious enhancement in arterial phase should be combined with CT signs and enhancement patterns for synthetic judgment, which is helpful to provide an important basis for the qualitative and differential diagnosis of liver lesions.

Clinical and laboratory features distinguishing between Deinagkistrodon acutus and Daboia siamensis envenomation

There are 6 species of venomous snakes in Taiwan. Two of them, Deinagkistrodon acutus (D. acutus) and Daboia siamensis (D. siamensis), can cause significant coagulopathy. However, a significant proportion of patients with snakebites cannot identify the correct snake species after envenomation, which hampers the application of antivenom. Hence, the differential diagnosis between the two snakebites by clinical presentations is important. This study aims to compare their clinical and laboratory features for the purpose of differential diagnosis between the two snakebites. Methods: We retrospectively reviewed the medical records of patients who arrived at the emergency department due to D. acutus or D. siamensis envenomation, between 2003 and 2016, in one medical center in eastern Taiwan. Since these snakebites are rare, we also included 3 cases reported from another hospital in central Taiwan. Results: In total, 15 patients bitten by D. acutus and 12 patients by D. siamensis were analyzed. Hemorrhagic bulla formation and the need for surgical intervention only presented for D. acutus envenomation cases (Both 53.3% vs. 0.0%, P= 0.003). As to laboratory features, lower platelet counts (20.0 × 103/µL [interquartile range, 14-66 × 103/µL] vs. 149.0 × 103/µL [102.3-274.3 × 103/µL], P = 0.001), lower D-dimer level (1423.4 µg/L [713.4-4212.3 µg/L] vs. 12,500.0 µg/L [2351.4-200,000 µg/L], P = 0.008), higher proportion of patients with moderate-to-severe thrombocytopenia (platelet count < 100 × 103/µL) (80% vs. 16.7%, odds ratio (OR) = 20.0, 95% CI, 2.77-144.31; P = 0.002), and lower proportion of patients with extremely high D-dimer (> 5000 ng/mL) (16.7% vs. 66.7%, adjusted OR = 0.1 (95% CI, 0.01-0.69; P = 0.036) were found among cases of D. acutus envenomation compared to D. siamensis envenomation. The combination of hemorrhagic bulla, thrombocytopenia, and a lack of extremely high D-dimer had good discriminatory power (area under the curve (AUC) = 0.965; 95% CI, 0.904-1.00) for distinguishing D. acutus from D. siamensis envenomation. Conclusions: The presentation of moderate to severe thrombocytopenia (platelet count < 100 × 103/µL) and hemorrhagic bulla formation may indicate D. acutus envenomation. However, the envenomed patient with extremely high D-dimer levels may indicate a D. siamensis envenomation. These findings may help diagnose and select the right antivenom in patients with unknown snakebites who present significant coagulopathy.(AU)

Analysis of laparoscopic and open radical resection for hilar cholangiocarcinoma of type Bismuth-I / 中国内镜杂志

Objective To investigate the clinical effect of laparoscopic and open radical resection of hilar cholangiocarcinoma (Bismuth-I). Methods From January 2011 to January 2017, 34 patients (10 patients in the laparoscopic group and 24 patients in the open group) underwent radical resection of hilar cholangiocarcinoma. Their clinical data were analyzed retrospectively. Results All these patients underwent radical resection of hilar cholangiocarcinoma of type Bismuth-I successfully. The volume of blood loss was (179.50 ± 98.05) ml and duration of hospital stay was (11.80 ± 2.49) d of laparoscopic group which was lower than (261.25 ± 97.33) ml, (16.25 ± 3.35) d of open group (P < 0.05). The levels of Tbil of laparoscopic group at days after operation 1, 3, 5 d were (102.20 ± 45.49) mmol/L, (83.57 ± 30.66) mmol/L, (45.09 ± 18.41) mmol/L. The levels of Tbil of open group at days after operation 1, 3, 5 d were (148.17 ± 62.78) mmol/L, (121.60 ± 43.35) mmol/L, (80.59 ± 43.89) mmol/L. The difference was statistically significant (P < 0.05). And the laparoscopic group postoperative number of lymph nodes dissected (9.79 ± 3.05), postoperative complications (1 cases), positive margin (0 cases); and open group(9.30 ± 3.06), 3 cases, had no statistically significant differences were compared (P >0.05). Two groups of patients were followed up for 6~18 months. During the follow-up period, there was no recurrence or metastasis in the two groups. Conclusion Laparoscopic Bismuth-I radical resection of hilar bile duct carcinoma in lymph node dissection, postoperative complications, positive margin rate, prognosis and open type Bismuth-I hilar cholangiocarcinoma radical operation of similar effects, and more minimally invasive advantages. Therefore, laparoscopic radical resection for hilar cholangiocarcinoma of type Bismuth-I is safe and feasible.

Clinical observation of closed reduction and compression cannulated screw fixation for the treatment of femoral neck fracture in young and middle-aged patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of internal fixation with closed reduction and hollow compression screws for the treatment of femoral neck fracture in young and middle-aged patients.</p><p><b>METHODS</b>From June 2013 to December 2016, 33 young and middle-aged patients with femoral neck fractures were treated with hollow compression screws fixation including 17 males and 16 females with an average age of 38.5 years old ranged from 19 to 59 years old; 20 cases were on the left side and 13 cases on the right side;the time from injury to operation ranged from 2 to 5 days with an average of 3 days. According to Garden classification, 1 case were type I, 11 cases were type II, 18 cases were type III, 3 cases were type IV. During regular follow-up after operation, through the hip joint X-ray, the healing situation of bone and osteonecrosis were observed. The Harris score was used to evaluate the hip function of the final follow-up.</p><p><b>RESULTS</b>The operation time was from 30 to 50 minutes, the blood loss during operation was 20 to 70 ml. All patients were followed up for 8 to 42 months with an average of 24 months. At the final follow-up, the Harris score of hip joint was excellent in 18 cases, good in 10 cases, fair in 2 cases and poor in 3 cases. Among them, the pain scores were 40.61±5.08, function scores were 38.94±6.78, malformation scores were 3.88±0.69, motion range scores were 3.70±0.64 and the total scores were 87.12±11.98. Thirty cases achieved bone healing, the healing time was 4 to 12 months with an average of 7.5 months, 2 patients occurred with nonunion (Garden type IV), 1 patient with femoral head necrosis (Garden type IV). All patients had no postoperative infection, internal fixation loosening, refracture and other complications.</p><p><b>CONCLUSIONS</b>In treating the young and middle-aged patients with femoral neck fracture, closed reduction and hollow compression screw fixation has advantages of simple, stable fixation, less trauma, high rate of fracture healing, osteonecrosis of the femoral head with low risk and satisfactory clinical effect.</p>

Value of Internal Carotid Artery Stenosis in the Differential Diagnosis between Invasive Pituitary Adenoma and Invasive Meningioma / 中国医学科学院学报

Objective To assess the value of internal carotid artery stenosis in differentiating invasive pituitary adenoma (IPA) from invasive meningiomas (IM). Methods The clinical and imaging data of 28 IPA patients and 15 IM patients who were treated in our center from January 2012 to December 2016 were retrospectively analyzed. The magnetic resonance imaging (MRI) features were analyzed. The narrowest diameter (D) and area (A) of internal carotid artery around the tumor were measured by computed tomography angiography (CTA),followed by the calculation of the stenosis score (%). The diagnostic validity of the measured indicators were calculated by receiver operating characteristic (ROC) curve. Results The median Ki-67 was 3% (2%-5%) in IPA group,which was significantly higher than that in IM group (1%,1%-2%) (Z=-3.983,P=0.000). The tumor texture showed significant differences between these two groups (P=0.001). While there was no significant difference in the average diameter [(39.63±13.15)mm in IPA group vs. (37.09±16.13)mm in IM group (t=0.518,P=0.607)],the shape (P=0.010),T1WI (P=0.001),signal (P=0.000),post-gadolinium enhancement (P=0.000),separation from normal pituitary (P=0.001),dural tail sign (P=0.000),and skull (P=0.001) showed significant differences. ROC analysis showed that the AUC of Dwas 0.725 (P=0.006),the cut-off was 3.45 mm,the sensitivity was 62.50%,and the specificity was 76.47%;the AUC of Awas 0.737 (P=0.003),the cut-off level was 11.00 mm,the sensitivity was 75.00%,and the specificity was 64.71%;finally,the AUC of %was 0.711 (P=0.013),the cut-off level was 0.306,the sensitivity was 43.75%,and the specificity was 97.06%. Conclusions In addition to the common imaging features,the internal carotid artery stenosis is a valuable tool for differentiating IPA from IM. Three indicators including D,A,and %have moderate diagnostic validity.

Effects of protein PUMA-α on the apoptosis and fibrosis of human peritoneal mesothelial cells induced by high glucose / 解放军医学杂志

Objective To explore the effects of p53 up-regulated modulator of apoptosis (PUMA)-α protein on the apoptosis and fibrosis of human peritoneal mesothelial cells (HPMCs) induced by high glucose.Methods HPMCs were induced by 50mmol/L D type glucose or mannitol for 72 hours respectively,flow cytometry was employed to detect the rate of apoptotic cells,and theexpression levels of apoptosis-and fibrosis-related proteins were detected by Western blotting.The untreated HPMCs were transfected with Lenti-PUMA-α,and the treated cells were transfected with shRNA-PUMA-α,the number of apoptotic cells and the expression levels of apoptosis-and fibrosis-related proteins were detected with the methods mentioned above.Results Flow cytometry showed that the rate of apoptotic HPMCs increased after being induced by high glucose for 72 hours,and Western blotting revealed that the expression levels of pro-apoptotic and pro-fibrotic related proteins increased,but the arrestins of apoptosis and fibrosis-related proteins decreased.Up-regulation of PUMA-α promoted apoptosis and fibrosis,while down-regulation of PUMA-α alleviated apoptosis and fibrosis of HPMCs.Conclusion High glucose may accelerate apoptosis and fibrosis of HPMCs by up-regulating the expression of PUMA-α.

Clinical observation of endoscopic submucosal dissection for uppergastrointestinal ectopic pancreas (36 cases) / 中国内镜杂志

Objective To evaluate the feasibility, efficacy, and safty of endoscopic submucosal dissection (ESD) in treatment of uppergastrointestinal ectopic pancreas. Methods 36 uppergastrointestinal ectopic pancreas were treated with ESD from January 1 2012 to November 30 2014. The definitive histological diagnosis of ectopic pancreas was made after the endoscopic treatment. We analyzed the operation method, dissected tissue, complication, retrospec-tively. Results 34 cases were located in stomach, the other 2 in duodenum. All cases underwent ESD, the mean op-erating time was 66 min. The mean dissected tissue diameter was 21 mm × 16 mm in the 36 cases. The curative re-section rate was 100.00 %. Bleeding rate of ESD was 2.77 %(1/36). Perferation rate of ESD was 2.77 %(1/36). 2 cases suffered from low grade fever. None need surgical intervention. Recurrence rate was 0.00%. Conclusions ESD is a minimally invasive technique that allows resection of whole lesions and provides precise histological information, which is particularly suitable for uppergastrointestinal ectopic pancreas.

The role of SRF- miRNA-143-KLF-4 signal pathway in the HPMC phenotypic transition induced via high glucose / 解放军医学杂志

Objective To explore the role of Kruppel-like factor 4 (KLF-4) in phenotypic transition of human peritoneal mesothelial cells (HPMCs) induced via high glucose. Methods HPMCs were induced by 50mmol/L glucose for 72 hours, the expressions of epithelium-cadherin (E-cadherin), KLF-4, α-smooth muscle actin (-SMA), connective tissue growth factor (CTGF) and miRNA-143 were detected by Real-time PCR and Western blotting, respectively. The treated cells were transfected with LVKLF-4 and inhibitor, the untreated cells were transfected with shRNA-KLF-4 and mimic. The mRNA and protein expressions of KLF-4, E-cadherin, α-SMA, CTGF and miRNA-143 were detected by Real-time PCR and Western blotting, respectively. Results Real-time PCR showed that the expression of E-cadherin decreased and of α-SMA, CTGF and miRNA-143 increased, but of KLF-4 not changed in high glucose treated cells. Western blotting showed that the expression of KLF-4 and E-cadherin decreased. Upregulating KLF-4 increased the expression of E-cadherin, but decreased the expression of α-SMA and CTGF. Down-regulating KLF-4 decreased the expression of E-cadherin, but augment the expression of α-SMA and CTGF. Conclusion High glucose may induce the down-regulation of KLF-4 protein, and SRF- miRNA-143-KLF-4 signal pathway axis may be involved in the process of HPMC phenotypic transition.

Immunogenicity and prediction of epitopic region of antigen Ag I/II and glucosyltransferase from Streptococcus mutans / 华中科技大学学报（医学）（英德文版）

The levels of Streptococcus (S.) mutans infections in saliva were evaluated and a comparison for specific antibody levels among children with different levels of S. mutans infection was made. The promising epitopic regions of antigen AgI/II (PAc) and glucosyltransferase (GTF) for potential vaccine targets related to S. mutans adherence were screened. A total of 94 children aged 3-4 years were randomly selected, including 53 caries-negative and 41 caries-positive children. The values of S. mutans and those of salivary total secretory immunoglobulin A (sIgA), anti-PAc and anti-Glucan binding domain (anti-GLU) were compared to determine the correlation among them. It was found the level of s-IgA against specific antigens did not increase with increasing severity of S. mutans infection, and the complete amino acid sequence of PAc and GTFB was analyzed using the DNAStar Protean system for developing specific anti-caries vaccines related to S. mutans adherence. A significantly positive correlation between the amount of S. mutans and children decayed, missing, and filled teeth index was observed. No significant difference was detected in specific sIgA against PAc or GLU between any two groups. No significant correlation was found between such specific sIgA and caries index. A total of 16 peptides from PAc as well as 13 peptides from GTFB were chosen for further investigation. S. mutans colonization contributed to early children caries as an important etiological factor. The level of sIgA against specific antigens did not increase with increasing severity of S. mutans infection in children. The epitopes of PAc and GTF have been screened to develop the peptide-based or protein-based anti-caries vaccines.