Diagnostic value of cardiac magnetic resonance contrast medium perfusion and delayed contrast enhancement for early myocardial ischemia / 中国基层医药

Objective:To investigate the diagnostic value of cardiac magnetic resonance (CMR) contrast medium perfusion and delayed contrast enhancement for early myocardial ischemia.Methods:Ninety-one patients with coronary artery stenosis diagnosed by coronary angiography (CAG) between March 2020 and March 2022 in Yiwu Central Hospital were included in this study. These patients underwent first-pass perfusion cardiac magnetic resonance imaging and delayed enhancement examination. Arrival time ( t0), accumulative signal intensity (ASI), relative peak enhancement rate (SI%), maximum intensity of signal enhancement (SIp), and maximum curve slope (α) were statistically analyzed in the CMR contrast agent normal-dose perfusion and low-dose perfusion segments. The diagnostic value of CMR contrast agent perfusion versus CAG for early myocardial ischemia was determined. The signal intensity was compared between enhanced and non-enhanced areas of CMR contrast agent perfusion. Results:There were significant differences in ASI, SI%, SIp, and Slope (α) between normal perfusion and low perfusion segments ( t = 9.62, 10.65, 8.67, 6.93, all P < 0.05). There was no significant difference in the detection rate of lesioned vessels in early myocardial ischemia between CMR contrast agent perfusion and CAG [50.42% (120/238) vs. 51.68% (123/238), χ2 = 1.32, P = 0.163). There was a significant difference in the detection rate of lesioned vessels in myocardial ischemia between CMR contrast agent perfusion and CAG ( χ2 = 15.31, P < 0.001, r = 0.71). The signal intensity value in the delayed enhancement segment was significantly higher than that in the non-delayed enhancement segment [(598.43 ± 40.19) vs. (298.64 ± 70.58), t =19.85, P = 0.001). Conclusion:CMR contrast agent perfusion can effectively evaluate the severity of early myocardial ischemia and locate the diseased blood vessels. Delayed enhancement can determine the location and area of early myocardial ischemia, and can objectively reflect the severity of myocardial ischemia.

Risk factors for lymph node metastasis in T1 colorectal cancer and application value of its nomogram prediction model / 中华消化外科杂志

Objective:To investigate the risk factors for lymph node metastasis in T1 colorectal cancer and application value of its nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 914 patients with T1 colorectal cancer who underwent radical resection in the Zhongshan Hospital of Fudan University from June 2008 to December 2019 were collected. There were 528 males and 386 females, aged from 25 to 87 years, with a median age of 63 years. Observation indicators: (1) clinicopathological data of patients with T1 colorectal cancer; (2) follow-up; (3) analysis of influencing factors for lymph node metastasis; (4) development and internal validation of a nomogram predition model. Patients were regularlly followed up once three months within postoperative 2 years and once six months thereafter to detect tumor recurrence and survival. The endpoint of follow-up was at postoperative 5 years. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. Univariate and multivariate analyses were performed using the Logistic regression analysis. Based on results of multivariate analysis, a Logistic regressional nomogram for prediction of lymph node metastasis probability was constructed using R language software. The calibration curve was used to evaluate the consistency between probability predicted by the nomogram model and actual observation probability, which was reprensented by a consistency index. The Bootstrap method was used for evaluation of the model performance to receive the calibration curve. The Hosmer-Lemeshow test was used to calculate the goodness of fit in model. Results:(1) Clinicopathological data of patients with T1 colorectal cancer: 687 of 914 patients underwent direct surgery and 227 underwent remedial operation after endoscopic resection. All the 914 patients were confirmed as pT1NxM0 colorectal cancer by pathological examination. The tumor diameter was (2.3±1.2)cm. The pathological catogaries of 914 patients included 865 cases of adenocarcinoma and 49 cases of mucinous adenocarcinoma. The tumor differentiation degree of 914 patients included 727 cases of high or middle differentiation and 187 cases of low differentiation or undifferentiation. Of the 914 patients, 633 cases had submucosal infiltration depth ≥1 000 μm and 281 cases had submucosal infiltration depth <1 000 μm. There were 110 cases with nerve vessel invasion and 804 without nerve vessel invasion. The number of intraoperative lymph node dissection was 13 (range, 1-48). There were 804 cases in stage N0 of N staging, 98 cases in stage N1 and 12 cases in stage N2. There was no perioperative death. (2) Follow-up: 886 of 914 patients were followed up for 25 months (range, 1-129 months). During the follow-up, 24 patients had tumor recurrence or metastasis. The 5-year cumulative tumor recurrence rate of 914 patients was 4.8% and the median recurrence time was 17.0 months. Liver was the main site of tumor recurrence, accounting for 58.3%(14/24). The 5-year recurrence-free survival rate of 914 patients was 95.2%. The 5-year recurrence-free survival rate was 96.3% of 804 patients without lymph node metastasis, versus 86.6% of 110 patients with lymph node metastasis, showing a significant difference between the two groups ( χ2=6.83, P<0.05). (3) Analysis of influencing factors for lymph node metastasis: results of univariate analysis showed that preoperative carcinoembryonic antigen (CEA), preoperative CA19-9, tumor differentiation degree, submucosal infiltration depth, nerve vessel invasion were related factors for lymph node metastasis in T1 colorectal cancer ( odds ratio=2.56, 3.25, 2.21, 2.68, 3.39, 95% confidence interval as 1.41-4.67, 1.22-8.66, 1.43-3.41, 1.56-4.88, 2.10-5.48, P<0.05). Results of multivariate analysis showed that preoperative CEA ≥5 μg/L, preoperative CA19-9 ≥37 U/mL, poor differentiation or undifferentiation, submucosal infiltration depth ≥1 000 μm and nerve vessel invasion were independent risk factors for lymph node metastasis in T1 colorectal cancer ( odds ratio=2.23, 3.47, 2.01, 2.31, 2.91, 95% confidence interval as 1.02-4.15, 1.08-10.87, 1.03-3.27, 1.40-4.47, 1.64-5.13, P<0.05). (4) Development and internal validation of a nomogram predition model: based on results of multivariate Logistic analysis, a nomogram prediction model for lymph node metastasis in T1 colorectal cancer was developed. The nomogram score was 59 for preoperative CEA >5 μg/L, 100 for preoperative CA19-9 ≥37 U/mL, 48 for poor differentiation or undifferentiation, 67 for submucosal infiltration depth ≥1 000 μm and 92 for nerve vessel invasion, respectively. The total of different scores for different clinicopathological factors corresponded to the probability of lymph node metastasis. The receiver operating characteristic curve was drawed to evaluate the predictive performance of nomogram for lymph node metastasis in T1 colorectal cancer, with the area under curve of 0.70(95% confidence interval as 0.64-0.75, P<0.05). The Bootstrap internal validation of predictive performance in the nomogram predition model showed a consistency index of 0.70 (95% confidence interval as 0.65-0.75). The calibration chart showed a good consistency between the probability predicted by the nomogram model and actual probability of lymph node metastasis. The Hosmer-Lemeshow test showed a good fitting effect in model ( χ2=1.61, P>0.05). Conclusions:Preoperative CEA ≥5 μg/L, preoperative CA19-9 ≥37 U/mL, poor differentiation or undifferentiation, submucosal infiltration depth ≥ 1 000 μm and nerve vessel invasion are independent risk factors for lymph node metastasis in T1 colorectal cancer. The constructed nomogram model can help predict the probability of lymph node metastasis in T1 colorectal cancer.

Effect of nanohydroxyapatite on surface mineralization in acid-etched dentinal tubules and adsorption of lead ions / 南方医科大学学报

OBJECTIVE@#To study the effect of nanohydroxyapatite (nHA) for promoting surface mineralization of demineralized dentin discs and adsorption of lead ions in simulated sewage water.@*METHODS@#Sixty dentin disks were prepared from freshly extracted teeth with intact crown (including 30 premolars and 30 molars) and treated with 10% citric acid for 2 min to simulate dentinal tubules with dentin hypersensitivity. The etched dentin discs were brushed with distilled water, 0.2 g HA or 0.2 g nHA for 2 min twice a day for 7 consecutive days, after which scanning electron microscopy (SEM) was performed and calcium and phosphorus contents in the dentin discs were detected using EDS. Lead ion adsorption capacities of HA and nHA were tested by mixing 1 mL serial concentrations of HA and nHA suspensions with 50 mL lead ion solutions (1.0 mg/L). After 24 h, the residual lead ion concentration in the supernatant was measured using ICP to calculate lead ion adsorption rate and adsorption capacity of the materials.@*RESULTS@#SEM showed a smooth surface and empty dentin tubules in the acid- etched dentin dics. The dentin dics treated with HA were covered with masses of particles that loosely attached to the surface, and the diameter of the dentin tubules was reduced. In nHA group, the dentin discs showed a fine and homogeneous surface clogging with a tight attachment, and the dentin tubule diameter was obviously reduced. Daily brushing with HA and nHA, especially the latter, significantly increased calcium and phosphorus contents on the surface of the dentin dics ( < 0.000). In lead ion adsorption experiment, the lead ion adsorption rate of HA decreased as its concentration increased with the highest adsorption rate of 83.01%; the adsorption rate of nHA increased with its concentration until the adsorption equilibrium was reached, and its highest adsorption rate was 98.79%. A good liner relationship was found between the adsorption ability and concentration of HA.@*CONCLUSIONS@#Compared with HA, nHA has a better capacity for surface mineralization of acid-etched dentin discs and also a better ability of lead ion adsorption.

Cerebroplacental ratio and aortic isthmus systolic index in evaluation on pregnancy outcome of late-onset fetal growth restriction / 中国介入影像与治疗学

Objective: To explore the value of cerebroplacental ratio (CPR) and aortic isthmus systolic index (ISI) in evaluation on pregnancy outcome of late-onset fetal growth restriction (FGR). Methods: Totally 88 pregnant women with clinically confirmed late-onset FGR were retrospectively analyzed, among them 39 had poor pregnancy outcomes (case group) and 49 had good pregnancy outcomes (control group). CPR and ISI of fetuses were compared between 2 groups. ROC curve was used to analyze the value of CPR and ISI in predicting fetal pregnancy outcomes. Results: CPR and ISI of case group were lower than those of control group (both P<0.01). ROC curve results showed that taken 1.25 as the cut-off value of CPR, the sensitivity and specificity of adverse pregnancy outcome was 82.1% and 59.7%, respectively, and AUC was 0.814; while taken -0.44 as the cut-off value of CPR, the sensitivity, specificity and AUC was 94.9%, 82.7% and 0.930, respectively. Conclusion: Both CPR and ISI had predictive value for fetal adverse pregnancy outcome of late-onset FGR, and ISI was superior to CPR.

Advances in Study on Statins in Prevention of Colorectal Cancer / 胃肠病学

Statins,the inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A(HMG-CoA)reductase,are mostly prescribed for the treatment of hyperlipidemia and prevention of cardiovascular events. Several studies have suggested that statins can reduce the risk of colorectal cancer,however,there is still a debate on its chemopreventive effect. This article summarized the local and overseas studies focusing on this issue,and made a brief overview on the effect of statins in prevention of colorectal cancer and adenoma and its potential mechanisms.

Effect of Lipopolysaccharide and HMGB1 on murine macrophage polarization / 实用医学杂志

Objective This study was performed to investigate the infection of Lipopolysaccharide(LPS) and its downstream cytokine High-mobility Group Box 1(HMGB1)on the transcriptional regulation of macrophage polarization.Methods The murine macrophage cell line RAW246.7 was stimulated with LPS and HMGB1 respec-tively.The levels of M1 macrophage related mRNA(NOS2,TNF-α,IL-6)and M2 related mRNA(ARG-1,RELM-α)were determined by Q-PCR.Results The expression of M1 macrophage related mRNA(NOS2,IL-6,TNF-α) was significantly upregulated(P<0.01),while the M2 macrophage related mRNA(ARG-1,RELM-α)was down-regulated(P > 0.05)after the stimulation of LPS. Both the M1 and M2 related markers were upregulated at the mRNA level in HMGB1 stimulate group,and the upregulation of NOS2,TNF-α and RELM-α was statistically sig-nificant(P<0.01).Conclusions LPS induces the M1 polarization of murine macrophage,which involved in the inflammation reaction.HMGB1,as the downstream cytokine of LPS signaling,induces both M1/M2 polarization of murine macrophage. It′s inferred that HMGB1 intensifies periodontal inflammatory responses and,at the same time,involves the negative feedback mechanism in the responses to tissue remodeling.

Clinical effect of minimally invasive extraction of anterior tooth residual root by root separation / 实用医学杂志

Objective To investigate the clinical effect of minimally invasive extraction of anterior tooth residual root after root separation.Methods A total of 400 patients receivinganterior tooth residual root extraction were collected in the clinic of oral and maxillofacial surgery department between January 2015 and December 2016.The patients were divided into a control group and a study group according to their sequence to see the doctor,with an odd for the study group and an even for the control group.In the study group,residual roots were separated mesiodistally by high speed turbine before using minimally invasive extraction tool;while in the control group residual roots were extracted only using minimally invasive extraction tool.The surgical duration,postoperative damage rate of the lip side plate,degree of pain and patient satisfaction in the two groups were analyzed.Results The surgical duration was shorter in the study group compared with the control group (P ＜ 0.05).The postoperative damage rate of the lip side plate and the degree of pain were lower,while patient satisfaction was higher in the study group than in the control group (P ＜ 0.05).Conclusions The postoperative damage rate of the lip side plate is significantly lower in minimally invasive extraction of anterior tooth residual root after root separation.Smaller trauma is conducive to the implant afterwards.Root separation in minimally invasive extraction of anterior tooth residual root is valuable for clinical application.

Antimicrobial resistance and molecular epidemiology of 116 strains of me-thicillin-resistant Staphylococcus aureu in Xuzhou area / 中国感染控制杂志

Objective To investigate infection status and antimicrobial resistance mechanism of methicillin-resistant Staphylococcusaureus(MRSA),and provide reference for the rational antimicrobial use in clinic. Methods Staphylococcusaureus (SA)isolated from various specimens in Xuzhou area in 2012-2015 were collected,MR-SA strains were preliminarily screened by cefoxitin disk diffusion method,and confirmed by amplification of mecA gene,antimicrobial resistance of MRSA was determined by Kirby-Bauer method,minimal inhibitory concentration (MIC)was measured by E-test method,genotypes of staphylococcal chromosomal cassette mec(SCCmec)were de-termined by multiplex PCR. Results A total of 116 strains of MRSA were identified among 210 SA strains in 2012-2015,114 of which were positive for mecA gene,the total detection rate of MRSA was 55.24% . Susceptibility rates of MRSA to vancomycin,quinupristin/dalfopristin,and linezolid were all 100% ,resistance rates of MRSA to chloramphenicol and furantoin were both low,which were 15.52% and 1.72% respectively,resistance rates of MR-SA to 10 kinds of antimicrobial agents were all>80% ;resistance rates of MRSA to penicillins,aminoglycosides, macrolides,quinolones,sulfanilamide,rifampicin,tetracycline,and clindamycin were all higher than methicillin-sensitive Staphylococcusaureus(MSSA). MICs of vancomycin to MRSA in 2012-2015 were all 1.0μg/mL,MIC90 were all 1.5μg/mL,one MRSA isolate was with a vancomycin MIC of 2.0μg/mL in 2015. MRSA typing results of 116 MRSA isolates showed that SCCmec II,SCCmec III,and SCCmec IV accounted for 9.48% (n= 11),73.28% (n= 85),and 1.72% (Iva,n= 2;IVb,n= 2)respectively,13.79% (n= 16)of MRSA isolates were nontypeable, SCCmec I and SCCmec V type strains were not found. Conclusion MRSA is seriously multidrug-resistant,the drift has not been discovered in MIC value of vancomycin against MRSA,the major SCCmec genotype of MRSA is SCCmec III,infection control measures should be taken to control MRSA infection.

Expression of Dual-specificity Phosphatase 6 in Ovarian Serous Epithelial Carcinomas and Its Clinical Significance / 中国医科大学学报

Objective To investigate the expression of dual-specificity phosphatase 6 (DUSP6) in ovarian epithelial serous tumors and the relationship between DUSP6 expression and the clinicopathological parameters of ovarian serous cystoadenocarcinoma.Methods The expression of DUSP6 was analyzed by immunohistochemistry.Relationships between the expression of DUSP6 and the clinicopathological parameters of ovarian serous cystadenocarcinoma were also analyzed.Results DUSP6 expression was lower in patients with ovarian serous cystadenocarcinoma group with serum CA125 levels of less than or equal to 900 U/mL than in patients with serum CA125 levels of greater than 900 U/mL (P ＜ 0.05) and in patients whose ascites volume was less than or equal to 500 mL than in patients whose ascites volume was greater than 500 mL (P ＜ 0.05).Conclusion DUSP6 is related to the occurrence of ovarian serous carcinoma and is potentially related to the peritoneal metastasis of ovarian serous carcinoma.DUSP6 may be a new molecule for the early diagnosis and therapy of ovarian serous carcinoma and peritoneal metastasis.

Value of antibiotic prophylaxis after endoscopic retrograde cholangio-pancreatography / 中华消化杂志

Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.

Analysis of Clinical,Endoscopic and Pathological Characteristics of Inflammatory Bowel Disease / 胃肠病学

Background:Inflammatory bowel disease (IBD)is a group of chronic gastrointestinal inflammatory disease and its diagnosis depends on analysis of clinical,endoscopic and pathological characteristics. Aims:To analyze the clinical, endoscopic and pathological characteristics of IBD. Methods:Clinical,endoscopic and pathological characteristics of 99 patients with IBD [including 61 ulcerative colitis (UC)and 38 Crohn's disease (CD)]from January 2010 to April 2017 at Yijishan Hospital were retrospectively analyzed. Results:Compared with CD patients,age in UC patients was significantly increased,incidences of diarrhea,bloody stool were significantly increased while incidence of abdominal mass was significantly decreased (P < 0. 05). Extensive type UC and ileocolonic type CD were common. Proportion of patients received 5-aminosalicylic acid (5-ASA)was significantly higher in UC than in CD (90. 2% vs. 71. 1%,P = 0. 014). Two UC patients achieved remission shown by endoscopy,and endoscopic remission achieved in 3 CD patients. The main pathological features of UC were cryptic branching (57. 1%),cryptic twisting (76. 2%),cryptic atrophy (54. 8%)and cryptic irregularity (28. 6%). Ulcer was seen in 78. 9% of CD patients with active chronic inflammation (mainly lymphocyte and plasmocyte infiltration),and the detection rate of non-caseating granuloma was 15. 8% . Conclusions:UC patients are characterized with older age,diarrhea,bloody stool and higher administration rate of 5-ASA,and the endoscopic features were mucosal bleeding and ulcers. Pathological characteristics of UC were mainly cryptic architectural change and inflammatory infiltration,while those of CD were mainly segmental lesions and chronic inflammation with lymphocyte and plasmocyte infiltration and some with non-caseating granuloma.

Risk factors for ERCP-related complications:a review of 1 951 cases / 中华消化内镜杂志

Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101(5.18%)pancreatitis, 54(2.77%)hyperamylasemia(not including pancreatitis), 134(6.87%) biliary infection,8(0.41%)hemorrhage,1(0.05%)obstruction and 1(0.05%)perforation.Multivariate analyses showed cholangiocarcinoma(P=0.002,OR=2.39, 95% CI:1.38-4.14), long operation time(>60 min)(P=0.020,OR=3.77,95%CI:1.23-11.53)and endoscopic sphincterotomy(EST)(P=0.008, OR=2.56,95% CI:1.28-5.14)and entrance of guidewire to pancreatic duct(P=0.012,OR=1.43, 95%CI:1.08-1.87)were independent risk factors for PEP. Cholangiocarcinoma(P<0.01, OR=2.93, 95%CI:1.88-4.56),multiple times of ERCP during the period of hospitalization(P<0.01, OR=2.53, 95%CI:1.63-3.93)were independent risk factors for post-cholangitis. However, EST(P=0.03, OR=0.65,95%CI:0.44-0.97)and antibiotics prophylaxis after ERCP(P=0.03, OR=0.64, 95% CI:0.39-0.95)were protective factors for post-cholangitis. ConclusionCholangiocarcinoma, endoscopic sphincterotomy, long operation time(> 60 min)and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis.EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis.

Application of robotic surgical system in sphincter-preserving surgery for low rectal cancer / 中华胃肠外科杂志

Robotic surgical system has been widely applied in sphincter-preserving surgery for low rectal cancer with the advantages of clear 3D images and stably flexile manipulation. Its application principle includes radical resection of tumor and complete preservation of function. The main operation procedures of robotic surgical system in sphincter-preserving surgery for low rectal cancer are as follows: (1) Anterior resection of low rectal cancer: It is safe and feasible and has obvious advantages in observation of pelvic nerves, dissociation of presacral and sacral side, and high rate of sphincter-preserving, while the improvement of postoperative recovery and long-term survival needs to be verified by further large sample researches. (2) Per anus intersphincteric resection (ISR): It is mainly applied in T1 and T2 stage tumors with 2 cm distance from tumor low margin to anal edge after dissociation of mesorectum. The greater difficulty of manipulation is found in ISR, while robotic surgical system can complete the intersphincteric resection by transabdominal approach, but anal function may be affected with the possibility of feces spillage at night, so robotic ISR is now still in exploration stage. (3) Transanal everted pull-through resection (Welch resection): Associated application of this operation is rarely reported at home and abroad. Our department has completed 51 robotic procedures of Welch resection till March 2017. Welch resection is successfully performed in all the patients. The short-term clinical outcomes are quite satisfactory and long-term survival is followed up. We think that this procedure is safe and feasible under the strict mastering of indications. Owing to special manipulation advantages of quickly precise dissociation, cutting and anastomosis in small pelvic space, when compared to laparoscopic surgery, robotic surgical system has higher sphincter-preserving rate for low rectal cancer, however, no other advantages are found. We believe that with the development of surgical instruments and ongoing of large sample studies, robotic surgical system will play a more important role in the treatment of low rectal cancer.

Robotic surgery for colorectal cancer in elderly patients / 中华胃肠外科杂志

The outstanding advantages of robotic surgery include the stable and three-dimension image and the convenience of surgery manipulation. The disadvantages include the lack of factile feedback, high cost and prolonged surgery time. It was reported that robotic surgery was associated with less trauma stress and faster recovery in elderly patients(≥75 years old) when compared with open surgery. Elderly people have a higher incidence of carcinogenesis and also have more comorbidities and reduced functional reserve. Clinical data of patients over 75 years old treated by robotic surgery in Zhongshan Hospital affiliated to Fudan University from March 2011 to October 2014 were analyzed retrospectively. A total of 24 consecutive patients were included with a median age of 77.8 years old. There were 18 male and 6 female patients. Among them, 14 patients were diagnosed with descending and sigmoid colon cancers while 10 with rectal cancers; 19 had tumor size larger than 5 cm; 16 were diagnosed with ulcerative adenocarcinoma. Fourteen patients were complicated with hypertension, 6 with cardiopulmonary diseases, 4 with diabetes mellitus and 3 with cerebrovascular diseases. Twenty-two patients underwent low anterior resection and 2 abdominoperineal resection. The estimated blood loss was 85 ml; the median operation time was (123.1±45.2) min; the median number of retrieved lymph node was 12.4. Postoperative pathologic results showed that 3 patients were stage I, 10 stage II, and 11 stage III. Postoperative complication was observed in 3 patients: urinary infection in 1 case, intraperitoneal infection in 1 case and atria fibrillation in 1 case, respectively. Median time to first postoperative flatus was 2.8 days. Our results indicated that robotic surgery is safe and feasible in the elderly patients. The next generation of robotic system may make up for these deficiencies through new technologies. With the advantage of more advanced surgical simulator, robotic surgery will play a more important role in the treatment of colorectal cancer patients.

Analysis of long-term outcomes and risk factors in patients undergoing simultaneous resection of synchronous colorectal liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze long-term outcomes and related risk factors in patients undergoing simultaneous resection of synchronous colorectal liver metastasis.</p><p><b>METHODS</b>Clinicopathological, short- and long-term outcome data of 154 consecutive synchronous colorectal liver metastasis patients who underwent simultaneous resection between July 2003 and July 2013 were collected and analyzed with Cox multivariate methods retrospectively.</p><p><b>RESULTS</b>No perioperative death was found. A total of 46 patients (29.9%) had complications, which were all successfully treated medically or by percutaneous drainage. The 5-year overall survival rate was 46%, and the 5-year disease-free survival rate was 35%. Four factors were found to be independent predictors of poor overall survival by multivariate analysis: positive lymph node status (P=0.000), number of metastasis focus (≥4) (P=0.017), bilobar liver metastasis distribution (P=0.004) and non-R0 resection of liver metastasis (P=0.001). Three factors were found to be independent predictors of poor disease-free survival by multivariate analysis: positive lymph node status (P=0.031), bilobar liver metastasis distribution (P=0.001) and extrahepatic metastases (P=0.020).</p><p><b>CONCLUSIONS</b>Simultaneous resection of synchronous colorectal liver metastasis is safe and its short- and long-term outcomes are quite good. Positive lymph node status, number of metastasis focus (≥4), bilobar liver metastasis distribution, non-R0 resection of liver metastasis and extrahepatic metastasis are risk factors of poor long-term prognosis.</p>

Advances in competing endogenous RNA modulation of cancer progression / 肿瘤研究与临床

Protein-coding transcriptome,pseudogenes,long non-coding RNAs and circular RNAs can act as competing endogenous RNA (ceRNA).ceRNA can crosstalk with each other through microRNA recognition elements (MRE),thus regulating the post-transcriptional gene expression.More and more evidences showed that ceRNA could form an extensive network of post-transcription regulation,keep the cell homeostasis and involve in the disease development and progression like tumorigenesis and cancer progression.Depending on up-regulation or down-regulation of different kinds of microRNA in different cells,ceRNA acts as either an oncogene or a tumor suppressor.ceRNA may have a great potential in cancer diagnosis and treatment.

Effects of dentifrice containing hydroxyapatite particles with various grain sizes on the sorption of Cu (Ⅱ) ion from aqueous solution / 实用医学杂志

Objective To study the capacity of dentifrice containing hydroxyapatite (HA) particles with various grain sizes on the sorption of Cu (Ⅱ) ion from aqueous solution. Methods Three groups of dentifrice suspensions containing 3% HA particles with 60 nm grain size, 3% HA particles with 12 μm grain size, and blank dentifrice were prepared with serial concentrations. Copper ion solutions with initial concentration of 4.0 mg/L were mixed with dentifrice suspensions respectively and then been kept still for 24 hours. The residual copper ion concentration of the supernatant was measured by inductively coupled plasma emission spectrometer and the sorption rate of copper ion was calculated. Results The residual copper ion concentration of the supernatant decreased with increase of the concentration of dentifrice suspensions. The sorption rate of copper ion of dentifrice containing 60 nm HA was highest among the three groups. Conclusion Nano HA should be added into dentifrice to enhance the sorption capacity of copper ion from aqueous solution.

Effects of transforming growth factor beta 3 on the proliferation and mineralization of dental pulp stem cells from human deciduous teeth / 中国组织工程研究

BACKGROUND:The role of transforming growth factorβsuperfamily has been reported in bone mineralization of various types of stem cells, but the effects of transforming growth factorβ3 (TGF-β3) combined with heparin on proliferation and mineralization of dental pulp stem cells from human deciduous teeth remains to be studied. OBJECTIVE:To evaluate the effects of TGF-β3 on the proliferation and mineralization of dental pulp stem cells from human deciduous teeth. METHODS:The enzyme digestion method was utilized to separately culture dental pulp stem cells from human deciduous teeth. The cellcolony forming efficiency was determined. Flow cytometry was utilized to identify cellsurface marker CD146. Immunochemistry for Vimentin and STRO1 was performed to measure dental pulp stem cells from human deciduous teeth. The third passage dental pulp stem cells from human deciduous teeth cultured in vitro were intervened with heparin and TGF-β3 of 1, 5, 25μg/L mass concentration. The MTS method was applied to measure cellgrowth curves. Alizarin red staining was carried out. The changes in alkaline phosphatase activity were determined with alkaline phosphatase kit. RESULTS AND CONCLUSION:The cellcolony forming efficiency was high. cells were positive for CD146, and strongly positive for Vimentin and STRO1. Dental pulp stem cells from human deciduous teeth were identified. MTS assay indicated that there was no obvious effect on promoting proliferation of dental pulp stem cells from human deciduous teeth after stimulation of TGF-β3. Detection results of alkaline phosphatase activity demonstrated that the combination of TGF-β3 and heparin could strengthen the alkaline phosphatase activity of dental pulp stem cells from human deciduous teeth with increased concentration. Alkaline phosphatase activities were significantly higher in the TGF-β3+heparin group, TGF-β3 group and heparin group than in the control group (P<0.01). Alizarin red staining was positive in the TGF-β3+heparin group, and the staining was strongest in the 5μg/L TGF-β3+heparin group. Results indicated that TGF-β3 combined with heparin promoted mineralization of dental pulp stem cells from human deciduous teeth.

Transforming growth factor beta 3 induced odontoblast-like differentiation of stem cells from human exfoliated deciduous teeth / 中国组织工程研究

BACKGROUND:Studies have reported that the superfamily of transforming growth factors exert a role in the mineralization of various stem cells, but the combination effects of transforming growth factorβ3 and heparin on proliferation and mineralization ability of stem cells from human exfoliated deciduous teeth remains to be studied. OBJECTIVE:To explore the effect of transforming growth factorβ3 on odontoblast-like differentiation of stem cells from human exfoliated deciduous teeth. METHODS:Human deciduous teeth were col ected using enzyme digestion. The 3rd cells were incubated with 25μg/L recombinant human transforming growth factorβ3, 10 U/mL heparin or their combination. The dentin sialophosphoprotein mRNA and dentinsialoprotein expressions were detected by Q-PCR and western blot assay. Alkaline phosphatase activity was determined using alkaline phosphatase kit. RESULTS AND CONCLUSION:Stem cells from human exfoliated deciduous teeth grew wel after induction. The activity of alkaline phosphatase in the combination group was significantly higher than that in the transforming growth factorβ3, heparin and control groups (P<0.01). After combination induction, the cells were strongly positive for alizarin red staining. Results fromα-PCR and western blot assay showed that the expressions of dentin sialophosphoprotein were both remarkably increased at mRNA and protein levels. In summary, stem cells from human exfoliated deciduous teeth can differentiate into odontoblast-like cells under the induction of transforming growth factorβ3 plus heparin.

Differentiation of odontoblast-like cells from human exfoliated deciduous teeth-derived stem cells by transforming growth factor β3 in combination with heparin in vitro / 实用医学杂志

Objective To investigate the ability of human exfoliated deciduous teeth-derived stem cells (SHED) to differentiate into odontoblast-like cells. Methods SHEDs were isolated by enzyme digestion method. The 3nd passage SHEDs were incubated with 25 ng/mL recombinant human TGF-β3 , or with TGF-β3 in combination with heparin. The DSPP expression was detected by Q-PCR and Western-blotting assay. Alizarin red staining, immunhistochemistry assay and alkaline phosphatase(AKP) activity assay were performed, respectively. Result The AKP activity was enhance by TGF-β3 in combination with heparin. Alizarin red staining was positive in TGF-β3-heparin groups, with the increase of DSPP expression at both mRNA and protein level. Conclusion TGF-β3 in combination with heparin can enhance the differentiation of human exfoliated deciduous teeth-derived stem cells into odontoblast-like cells.