Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

ABSTRACT Hypothesis: Endoclip can be used as fiducial marker in urology. Objective: To assess the feasibility, cost effectiveness and reliability of endoclips as novel fiducial markers in precision radiotherapy, as part of a trimodality bladder-preserving treatment (TBPT) of muscle-invasive bladder carcinoma. Materials and Methods: This retrospective study was performed at Weifang People's Hospital (Weifang, China) from January 2015 to June 2018. A total of 15 patients underwent TBPT. Endoclips were applied to healthy edges of the resected bladder wall as novel fiducial markers. Radio-sensitizing chemotherapy and routine precision radiotherapy were given. The number and position of the endoclips during radiotherapy sessions were monitored. Complications and tumor recurrence were analyzed. Results: The mean age (±standard deviation) of the patients was 67±10 years (range 46-79). There were 3 females and 12 males. Forty-nine endoclips were applied in all patients (3.3±0.8). The tumor was completely visibly resected in all patients. The number of endoclips remained the same through the planned last radiotherapy session (3.3±0.8), i.e., none were lost. All endoclips were removed after the last radiotherapy session. The average number of follow-up months was 38.9±13.2 (range 11-52). There were no procedure-related complications at discharge or follow-up. At one-year, overall recurrence-free survival was 93.3%. Two patients had recurrences at 18 months and 10 months after TBPT, respectively, and salvage radical cystectomy was performed with no further recurrences. Another patient died due to metastasis 9 months after the completion of therapy. Conclusions: Endoclips are reliable, safe and cost-effective as novel fiducial markers in precision-radiotherapy post-TBPT.

Metformin improved oxidized low-density lipoprotein-impaired mitochondrial function and increased glucose uptake involving Akt-AS160 pathway in raw264.7 macrophages / 中华医学杂志(英文版)

BACKGROUND@#Macrophage accumulation in the vascular wall is a hallmark of atherosclerosis. Studies showed that shifting of oxidized lipids-induced inflammatory macrophages towards an anti-inflammatory phenotype by promoting oxidative metabolism attenuated atherosclerosis progression. Therefore, this study aimed to investigate whether metformin, which has ameliorated atherosclerosis in animal models and clinical trials, modulated oxidized low-density lipoprotein (Ox-LDL) induced inflammatory status in macrophages by regulating cellular oxidative metabolism.@*METHODS@#Murine raw264.7 macrophages were incubated with Ox-LDL (50 μg/mL) in the presence or absence of metformin (15 μmol/L) for 24 h. Real-time polymerase chain reaction was used to quantify the transcription of classically activated (M1) pro-inflammatory and alternatively activated (M2) anti-inflammatory markers and mitochondrial DNA copy numbers. Cellular reactive oxygen species (ROS) production and mitochondrial membrane potential were detected by immunofluorescence. Cellular adenosine triphosphate (ATP) synthesis, glucose uptake, and lactic acid production were measured by commercial kit and normalized to cellular lysates. Western blotting analysis was performed to detect the expression of mitochondrial fusion/fission related proteins, enzymes mediating lipid metabolism and signaling pathway of glucose transport. Differences between groups were analyzed using one-way analysis of variance.@*RESULTS@#Metformin improved Ox-LDL-impaired anti-inflammatory phenotype in raw264.7 macrophages as shown by up-regulated transcription of anti-inflammatory markers including interleukin 10 (0.76 ± 0.04 vs. 0.94 ± 0.01, P = 0.003) and Resistin-like molecule alpha (0.67 ± 0.08 vs. 1.78 ± 0.34, P = 0.030). Conversely, Ox-LDL-diminished phosphorylation of Akt was up-regulated by metformin treatment (0.47 ± 0.05 vs. 1.02 ± 0.08, P = 0.040), associated with an improvement of mitochondrial function, characterized by decreased ROS generation (2.50 ± 0.07 vs. 2.15 ± 0.04, P = 0.040), increased lipid oxidation, and elevated cellular ATP production (0.026 ± 0.001 vs. 0.035 ± 0.003, P = 0.020). Moreover, metformin-mediated Akt activation increased Akt substrate of 160 kDa (AS160) phosphorylation (0.51 ± 0.04 vs. 1.03 ± 0.03, P = 0.0041), promoted membrane translocation of glucose transporter 1, and increased glucose influx into the cells (4.78 ± 0.04 vs. 5.47 ± 0.01, P < 0.001).@*CONCLUSION@#This study suggested that targeting macrophage metabolism with new or existing drugs had therapeutic potential for the prevention and treatment of diabetes-accelerated atherosclerosis.

Analysis of injury epidemiological characteristics in children aged 0-14 years in Suzhou / 中华疾病控制杂志

Objective To investigate the epidemiologic features of injuries in children aged 0-14 years in Suzhou, so as to provide targeted education and prevention guidance for parents and schools. Methods Complex sampling was used to choose 4 989 children aged 0-14 years in Gusu and Wujiang districts in Suzhou. The primary caregivers filled out an injury occurrence questionnaire to analyze the distributions of injury numbers, occurrence time and locations. Results In the past 12 months, the overall incidence of children injuries was 7.7%, with 95% confidence interval (CI) was 6.9%-8.4%. The incidence tended to decrease with age ( 2=5.06, P=0.025), however, increase with monthly increase ( 2=28.51, P<0.001).Of all types of children injuries, the incidence of fall was highest (65.5%). Head and face injuries were the most common (45.3%). Most of injuries occurred at home (59.5%) and during leisure play (32.2%). 81.3% of the injuries were slight, and 45.4% of the injuries were dealt with infirmaries. 9.7% of the injured children recovered with aesthetics impact. Young children were more likely to experience head fall or burn injuries during leisure play. Young girls were more likely to experience injuries at home. However, older children were more likely to have lower limb injuries during sports and housework. Older boys were more likely to be harmed at school. Conclusions Different age and gender children had different injury epidemiological characteristics. Specific preventive measures should be taken according to their characteristics.

Metformin improved oxidized low-density lipoprotein-impaired mitochondrial function and increased glucose uptake involving Akt-AS160 pathway in raw264.7 macrophages / 中华医学杂志(英文版)

Background@#Macrophage accumulation in the vascular wall is a hallmark of atherosclerosis. Studies showed that shifting of oxidized lipids-induced inflammatory macrophages towards an anti-inflammatory phenotype by promoting oxidative metabolism attenuated atherosclerosis progression. Therefore, this study aimed to investigate whether metformin, which has ameliorated atherosclerosis in animal models and clinical trials, modulated oxidized low-density lipoprotein (Ox-LDL) induced inflammatory status in macrophages by regulating cellular oxidative metabolism.@*Methods@#Murine raw264.7 macrophages were incubated with Ox-LDL (50 μg/mL) in the presence or absence of metformin (15 μmol/L) for 24 h. Real-time polymerase chain reaction was used to quantify the transcription of classically activated (M1) proinflammatory and alternatively activated (M2) anti-inflammatory markers and mitochondrial DNA copy numbers. Cellular reactive oxygen species (ROS) production and mitochondrial membrane potential were detected by immunofluorescence. Cellular adenosine triphosphate (ATP) synthesis, glucose uptake, and lactic acid production were measured by commercial kit and normalized to cellular lysates. Western blotting analysis was performed to detect the expression of mitochondrial fusion/fission related proteins, enzymes mediating lipid metabolism and signaling pathway of glucose transport. Differences between groups were analyzed using one-way analysis of variance.@*Results@#Metformin improved Ox-LDL-impaired anti-inflammatory phenotype in raw264.7 macrophages as shown by up-regulated transcription of anti-inflammatory markers including interleukin 10 (0.76 ± 0.04 vs. 0.94 ± 0.01, P = 0.003) and Resistin-like molecule alpha (0.67 ± 0.08 vs. 1.78 ± 0.34, P = 0.030). Conversely, Ox-LDL-diminished phosphorylation of Akt was upregulated by metformin treatment (0.47 ± 0.05 vs. 1.02 ± 0.08, P = 0.040), associated with an improvement of mitochondrial function, characterized by decreased ROS generation (2.50 ± 0.07 vs. 2.15 ± 0.04, P = 0.040), increased lipid oxidation, and elevated cellular ATP production (0.026 ± 0.001 vs. 0.035 ± 0.003, P = 0.020). Moreover, metformin-mediated Akt activation increased Akt substrate of 160 kDa (AS160) phosphorylation (0.51 ± 0.04 vs. 1.03 ± 0.03, P = 0.0041), promoted membrane translocation of glucose transporter 1, and increased glucose influx into the cells (4.78 ± 0.04 vs. 5.47 ± 0.01, P < 0.001).@*Conclusion@#This study suggested that targeting macrophage metabolism with new or existing drugs had therapeutic potential for the prevention and treatment of diabetes-accelerated atherosclerosis.

The role and clinical significance of αB-Crystallin in the proliferation and migration of non-small cell lung cancer / 复旦学报（医学版）

Objective To investigate the expression of αB-Crystallin in non-small cell lung cancer and adjacent tissues (NSCLC) and analyze the associations between its expression and clinicopathological features as well as proliferation and migration of NSCLC cells.Methods We down-regulated the expression of αB-Crystallin in NSCLC cell line A549 with specific siRNA,and assessed the role of αB-Crystallin in the proliferation and migration of NSCLC cell line with CCK-8 and Transwell.Then,we examined αB-Crystallin expression by immunohistochemistry (IHC) in tissue microarray (TMA) consisting of 208 cases of NSCLC who were treated in the Department of Thoracic Surgery,Zhongshan Hospital in 2005.Associations between αB-Crystallin expression and clinical characteristics were assessed and the prognostic role of αB-Crystallin in NSCLC was evaluated by Kaplan-Meier and Cox regression analysis.Results Loss of αB-Crystallin expression suppressed the proliferation and migration potential of A549 cells (P＜0.05).Furthermore,immunohistochemistry in tissue microarray revealed that αB-Crystallin was overexpressed in NSCLC compared with adjacent normal tissues,αB-Crystallin expression was associated with lymph node metastasis (P ＜ 0.05).Multivariate analysis indicated that αB-Crystallin expression was an independent prognostic factor in patients' overall survival.Conclusions Our finding indicated that αB-Crystallin was overexpressed in NSCLC and promotes proliferation and migration of NSCLC cells.Its expression was associated with poor prognosis of NSCLC patients.αB-Crystallin may represent a potential therapeutic target and a novel prognostic marker of NSCLC.

Electroconvulsive treatment for geriatric depression: a systematic review of randomized clinical trials / 上海交通大学学报（医学版）

Objective·To explore the clinical effectiveness and safety of electroconvulsive therapy (ECT) in elderly patients with depression.Methods·Searches were made in PubMed,EMBase,Web of Knowledge,CNKI,Wanfang,VIE CBMDisc databases and etc.CONSORT (Consolidated Standards of Reporting Trials) statement were used to assess the methodological quality of the studies.RevMan and STATA were used to do meta analysis.Results·Ten studies were included in this systematic review.The studies which used Hamilton depression rating scale (HAMD,n=5) and Montgomery-(A)sberg depression rating scale (MADRS,n=3) to access depressed symptom were analyzed.Sample size was 306 and 290 before and after treatment,respectively.The depressive symptoms were significantly improved after ECT treatment estimated by either HAMD (Z=6.39,SMD=3.64,P=0.000) or MADRS (Z=15.47,SMD=2.12,P=0.000).There was no difference of Mini-mental State Examination (MMSE) scores before and after the treatment (Z=1.47,P=0.140).The incidence of adverse events of headache,confusion,drowsiness,nausea and vomiting was more than 5％.Conclusion·Depressed symptoms are significantly improved in geriatric depression after ECT.The overall cognitive impairment is not obvious,but headache and disturbance of consciousness are common.

Gastrointestinal cancer influenced by genetic effect of cancer history of first-degree relatives / 上海预防医学

[Objective] To compare the influence of first-degree relatives' cancer history on the genetic tendency of gastric and colorectal cancer. [Methods] Patients with gastric and colorectal cancer from six towns of Suzhou City were investigated by means of face-to-face survey based on the "Family History and History of Population Diseases Questionnaire"which included general conditions, family composition and cancer occurrence of all their three degree relatives. [Results] If there were first-degree relatives with history of cancer, individual risk of gastric cancer would be higher than that of colorectal cancer by 55％, with the adjusted OR (95％ CI) being 1.551 (1.021, 2.356). If there were first-degree relatives with history of digestive tract cancer, the risk of the subject would increase to 104％, with the adjusted OR (95％CI) being 2.037 (1.279, 3.246). Men with first-degree relatives who had cancer history was at91％ higher risk of developing gastric cancer than colorectal cancer, with the adjusted OR (95％CI) being1.911 (1.080, 3.381). And for history of digestive tract cancer, the risk would reach 156％, with the adjusted OR (95％ CI) being 2.559 (1.337, 4.897). The number of cancers suffered by first-degree relatives of those patients with gastric cancer was higher than that of patients with colorectal cancer, with Z =-6.873, P<0.001, while the number of digestive tract cancer was also higher, with Z =-6.137, P<0.001. [Conclusion] The history of cancer and digestive tract cancer with first-degree relatives, is more common in patients with gastric cancer than with colorectal cancer. It is necessary to focus health education on men with first-degree relatives suffering from cancer or digestive tract cancer and suggest some changes in their living habits and regular medical examinations to reduce the occurrence of gastric cancer.

Scientific research reagents and consumables management mode based on network / 医疗卫生装备

Objective To explore a research reagents and consumables management method based on network to improve hospital reagents procurement management. Methods The current situation and existing problems of scientific research reagents and consumables management were introduced, and the necessity, significance and process of a network-based management mode were put forward. Results The newly-proposed management mode contributed to optimizing resources layout and controlling purchase process. Conclusion The network-based management mode enhances the efficiency of hospital consumables management,decreases the cost and improves hospital management. [Chinese Medical Equipment Journal,2018,39(5):81-83,96]

The impact of doctor's efforts and reputation on the number of new patients in online health community / 中国卫生政策研究

The aim of this paper is to study the impact of doctor and colleague's online efforts and reputation on the number of new patients,by analyzing the online data of haidaifu website in 2008—2016 based on panel negative binomial regression method. The doctors' degree of online effort includes the number of words and their timeliness of their reply. Online reputation includes material evaluation (i.e. gift amount) and non-material evaluation (i. e. thanks letter). Studies have shown that the efforts and reputations of doctors and their colleagues have a significant impact on the number of new patients,and colleagues also play a significant regulatory role. And competition and co-operative relationship also exist between doctors and colleagues.

Isolation and Characterization of Lactic Acid Bacteria Used for Ensiling Bamboo-shoot Shell.

Aims: To construct a stable and functional lactic acid bacteria community that can be used in the ensilage of bamboo-shoot shell to improve the taste and flavor. Methodology: Using naturally fermented bamboo-shoot shell as initial sample, a qualitative microorganism source had been prepared by the technique of continuous restricted sub cultivation. Then some colonies producing acid were selected by plate isolation and streaking from above source. Morphology & phenotype experiments, catalase test, GC-MS and 16S rRNA analysis were employed to identify the isolates. Finally, the ensilage experiment of moist bamboo-shoot shell was carried out to assess the potency of the selected lactic acid bacteria. Results: After a serial of sub cultivation, a stable and functional bacteria community producing acid had been constructed in the 23rd culture of bamboo-shoot shell. The bacteria community consisted of Lacto bacillus plantarum subsp. plantarum, Lactobacillus plantarum, Lactobacillus spp. T2R2C12 and Lactobacillus pentosus. Inoculated with the lactic acid strains, the culture pH of bamboo-shoot shell decreased sharply, meanwhile, the accumulation of lactic acid amounted to 4.01% at the end of ensiling. Conclusion: Continuous restricted sub cultivation is an effective technique to construct lactic acid bacterial community. Four strains of lactic acid bacterial were isolated successfully from naturally fermented bamboo-shoot shell. The strains can participate in the fermentation of forage made of bamboo-shoot shell.

Kinematic analysis on gait of overweight and obese primary school children during level walking / 医用生物力学

Objective To investigate the effects of overweight and obesity on the gait of primary school children by comparing the kinematic parameters between overweight/obese children and normal weight children during level walking. Methods Forty overweight/obese children (age: (9.6±1.72) year; height: (142.16±12.19) cm; BMI: (24.32±2.96) kg/m2) and 50 normal weight healthy children (age: (10.26±0.72) year; height: (139.0±7.50) cm; BMI: (17.08±1.25) kg/m2) were recruited as the subjects. All of the subjects completed 3 walking trials at preferred speed along a 10 m walkway with barefoot. A digital video camera was used to record these subjects’ level walking images, and their gait parameters, such as step length, stride length and joint angle of the lower extremity, were obtained through Shixun motion analysis system. SPSS 16.0 was used for data analysis. A paired t-test was used to assess differences of all the variables between lefe side and right side for the subjects. An independent t-test was used to assess differences of all the variables between the overweight/obese and normal weight children. Statistical significance was defined as P<0.05. Results (1) There were significant differences between overweight/obese children ((0.44±0.001)) and normal weight children ((0.45±0.001)) for relative step length (P<0.05). (2) There were significant differences in left hip and knee joint angle in the frontal plane between overweight/obese children (left hip angle: (165.36±5.29)°, left knee angle: (178.82±5.51)°, right knee angle: (177.84±5.25)°) and normal weight children (left hip angle: (161.99±4.28)°, left knee angle: (174.67±4.91)°, right knee angle: (174.67±4.91)°) during heel strike phase (P<0.05). Significant differences were found in the left ankle joint angle of the frontal plane during toe off phase between overweight/obese children((121.73±8.03)°) and normal weight children((118.44±6.70)°)(P<0.05). Conclusions Relative step length of overweight/obese children was significantly smaller than that of normal weight children during level walking. The left hip and knee joint angle in the frontal plane of overweight/obese children during heel strike phase were significantly larger than those of normal weight children. The left ankle joint angle in the frontal plane of overweight/obese children during toe off phase was significantly larger than that of normal weight children. These differences may affect the function of the lower extremity in overweight/obese children.

HIV-1 integrase inhibitory activity of endophytic fungi from Aquilaria sinensis (Lour.) Gilg / 中国药学杂志

OBJECTIVE: To investigate the HIV-1 integrase inhibitory activity of endophytic fungi from medicinal plant Aquilaria sinensis (Lour.) Gilg. METHODS: HIV-1 integrase inhibitory activity of the isolated endophytic fungi was determined by HIV-1 integrase strand transfer inhibitory activity assay, and the active metabolites of the endophytic fungi with the greatest potential were studied by activity tracking. RESULTS: Among 78 strains of endophytic fungi isolated from A. sinensis, nine strains (11.54%) showed strong inhibitory activity against HIV-1 integrase. Three compounds were obtained from the fermentation of strain HN-AS-8 which was identified to be Chaetomium globosum by HIV-1 integrase strand reaction. Compound 1 inhibited HIV-1 integrase with IC50 value of 35.4 μmol · L-1, and compounds 1 and 3 were for the first time isolated from Chaetomium sp. CONCLUSION: Potential anti-HIV-1 metabolites exist in the endophytic fungi from A. sinensis, which can be new resources for new anti-AIDS drugs.