Research advances in the role of blood metabolic markers in the treatment response and prognosis prediction of primary liver cancer / 临床肝胆病杂志

Primary liver cancer is one of the most severe cancer burdens around the world. Metabolic reprogramming is one phenotype of cancer， and blood metabolic markers are closely associated with metabolic reprogramming and can predict the risk of recurrence and survival or assess the treatment response of liver cancer， with important significance in the stratified management of patients， the development of rational treatment strategies， and the improvement of patient prognosis. By reviewing the recent studies on blood metabolomics in assessing the treatment response or predicting the prognosis of liver cancer， this article summarizes the blood metabolites with predictive significance and their mechanism of action and analyzes the current research status， existing problems， and prospects of this field. It is believed that the metabolites， such as aromatic amino acids， lipids， and bile acids， have an important clinical value in predicting the prognosis of liver cancer， and metabolomics technology has great potential in finding useful metabolites， but there are still many issues to be solved， such as technical limitations， insufficient studies， and multiple influencing factors.

The effect and mechanism of anwulignan on improving hepatic fibrosis in rats / 中国药房

OBJECTIVE To investigate the effect and mechanism of anwulignan on improving hepatic fibrosis in rats. METHODS Fifty SD rats were randomly divided into the normal group， model group， colchicine tablet group （0.1 mg/kg）， and anwulignan high-dose and low-dose groups （2.8 and 0.7 mg/kg）， with 10 rats in each group. Except for the normal group， all groups of rats were intraperitoneally injected with 50% CCl4 olive oil mixed solution to replicate the rat model of liver fibrosis. At the end of the modeling， rats in each group were given the corresponding drugs or distilled water intragastrically from the 9th week， once a day， for 4 weeks consecutively. During the experimental period， the general condition of the rats was observed； the liver index was calculated； the serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， superoxide dismutase （SOD） and malondialdehyde （MDA） were detected by colorimetric assay； the pathomorphology of the liver tissues and liver fibrosis were observed by HE staining and Masson staining； Western blot was used to detect the expression levels of phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） pathway and apoptosis-related proteins in liver tissues. RESULTS Compared with the normal group， the dietary amount of rats in the model group decreased， with sparse and disheveled fur， slow response， and a slower rate of weight growth or weight loss； the liver index was significantly increased （P＜0.01）； the serum levels of ALT， AST and MDA were significantly increased， and the SOD level was significantly decreased （P＜0.01）； HE and Masson staining showed that a large amount of fibrous proliferation was present in the liver tissues of the rats， and the collagen volume fraction was significantly increased （P＜0.01）； the protein expressions of PI3K， Akt， phosphorylated Akt and B-cell lymphoma （Bcl-2） were down-regulated significantly， while the protein expression of Bcl-2-associated X protein was increased significantly （P＜0.01）. Compared with the model group， the above indexes of the anwulignan high-dose and low-dose groups and the colchicine tablets group were all reversed significantly. CONCLUSIONS Anwulignan may reduce oxidative stress and inhibit hepatocyte apoptosis by activating the PI3K/Akt signaling pathway， and play the role of anti-hepatic fibrosis.

Study on Thalassemia in Han Population in Sanya of Hainan Province / 中国实验血液学杂志

OBJECTIVE@#To study the distribution characteristics of thalassemia genotype in Han Population in Sanya of Hainan Province.@*METHODS@#Gap PCR and reverse dot hybridization were used to detect and analyze the thalassemia gene in 572 suspected thalassemia carriers of Han Population in Sanya.@*RESULTS@#Among the 572 Han Population in Sanya, 271 cases of thalassemia gene abnormality were detected, among which 161 cases were founded to be carriers of α-thalassemia gene. A total of 9 genotypes were detected, in the following order of the detection rate was －－SEA/αα，－α3.7/αα，－α4.2/αα，－－SEA/－α3.7，－－SEA/－α4.2，－α4.2/－α4.2，－α3.7/－α4.2，－α3.7/－α3.7，－－SEA/－－SEA. Among them, the deletion type (－－SEA/αα) in southeast Asia was the most common, accounting for 66 cases. 99 cases of β-thalassemia were detected, there were 7 genotypes, all of which were heterozygous. The order of the detection rate was CD41-42/βN, IVS-II-654/βN, CD17/βN, CD71-72/βN, -28/βN, －29/βN, CD27-28/βN. Among them, CD41-42/βN was the most common, accounting for 51 cases. In addition, 11 cases of combined α and β thalassemia were detected. Five kinds of genotypes were checked out, the order of detection rate was －α3.7/αα composite CD41-42/βN, －－SEA/αα composite IVS-II-654/βN, －α4.2/－α4.2 composite CD41-42/βN, －α4.2/αα composite －29/βN , －－SEA/ －α4.2 composite CD41-42/βN.@*CONCLUSION@#Han Population in Sanya of Hainan Province is a high-risk population of thalassemia, the genotype characteristics are different from other areas with high incidence of thalassemia in China. The main type of α-thalassemia is the deficiency mutation of southeast Asia, while CD41-42 heterozygous mutation is the main type of β-thalassemia.

Effects of objective feedback applied in specialist nurses training of digestive endoscopy / 中华医学教育探索杂志

Objective:To evaluate the effects of objective feedback teaching applied in the specialist nurses training of digestive endoscopy.Methods:Six-eighty nurses participating in the training of specialist nurses of digestive endoscopy in Chongqing were recruited in the study, among which, 30 trainees in 2019 were assigned to the observation group, taking objective feedback teaching, and 38 trainees in 2018 were assigned to the control group, receiving traditional teaching. After the training, the two teaching methods were assessed through theoretical results, operation skills and comprehensive evaluation, and meanwhile a self-designed satisfaction questionnaire on the satisfaction of trainees was conducted. SPSS 25.0 was used to perform t-test, Chi-square test and Mann-Whitney U test. Results:The operation skills (84.90±4.92) and comprehensive quality (86.30±4.62) of observation group were higher than those of the control group [(82.39±4.10), (83.86±5.10)], with statistically significant differences ( P<0.05), while there was no significant difference in theoretical knowledge [(85.80±5.63) vs. (83.68±4.51), P>0.05]. Trainees were satisfied with the new training mode. Conclusion:The objective feedback teaching mode can improve the training effect especially on operation skills and comprehensive quality of the specialist nurses of digestive endoscopy, and insure the satisfaction of specialist nurses with the training.

Effect of Rhein on AQP4 and Microglia Mediated Inflammatory Response in Cerebral Ischemia Rats / 中国实验方剂学杂志

Objective:To investigate the effect of rhein on aquaporin 4 （AQP4） and brain edema after cerebral ischemia and the role of microglia-mediated inflammation in this process. Method:The modified thread embolization method was selected to establish the cerebral ischemia model of the right middle cerebral artery embolism （MCAO） in rats. The rats were divided into sham operation group， model group， minocycline group， and high， medium and low-dose rhein groups （3.46，1.73，0.865 mg·kg^-1）. The neurobehavioral function was measured by a modified neurobehavioral score. Wet and dry weight methods were used to measure the changes of water content in brain tissue of rats with cerebral ischemic injury. Western blot was used to detect the expressions of interferon-<italic>γ</italic> （IFN-<italic>γ</italic>） and interleukin-2 （IL-2） in the peripheral ischemic area of rats in each group. Immunofluorescence double labeling method was used to detect the expressions and localization of microglia fine markers Iba-1 and AQP4. Result:Compared with the sham operation group， neurological function score and water content on the side of brain tissue injury of the model group were significantly increased （<italic>P</italic><0.05）. Compared with the model group， the neurological function score and the water content of the brain tissue of each drug group were reduced （<italic>P</italic><0.05， <italic>P</italic><0.01）. Compared with sham operation group， the protein expressions of IFN-<italic>γ</italic> and IL-2 in the model group increased significantly （<italic>P</italic><0.05）. Compared with the model group， the protein expressions of IFN-<italic>γ</italic> and IL-2 in the peripheral area of cerebral ischemia of each drug group were significantly improved （<italic>P</italic><0.05， <italic>P</italic><0.01）. Immunofluorescence double staining results showed that compared with the sham operation group， the model group showed significant increase in the fluorescence expression of AQP4 protein on activated microglia， while each drug group could reduce the fluorescence expression of AQP4 protein on activated microglia， different levels of activated microglia markers Iba-1 and AQP4 were co-localized in the peripheral area of cerebral ischemia in each group. Conclusion:Rhein could reduce the degree of brain edema caused by cerebral ischemic injury， and its mechanism may be related to the inhibition of microglia-mediated neuroinflammation and the down-regulation of AQP4 expression.

Influence of electroacupuncture on the expression of AMPA receptor subunit GluR1 in the spinal injured area of the rats with acute spinal cord injury / 中国针灸

OBJECTIVE@#To explore the influence of electroacupuncture (EA) on the expression of AMPA receptor subunit GluR1 in the rats with acute spinal cord injury (SCI) and explore the potential effect mechanism of EA in treatment of acute SCI.@*METHODS@#A total of 80 SD rats were randomly divided into five groups, i.e. a sham-operation group, a model group, an AMPA antagonist (DNQX) group, an EA group and a DNQX+EA group, 16 rats in each group. The modified Allen's impacting method was adopted to prepare the rat model of acute SCI at T@*RESULTS@#Compared to the sham-operation group in 6 h, 24 h and 48 h after modeling, the BBB scores were all significantly decreased in the model group (@*CONCLUSION@#The intervention with EA at "Dazhui" and "Mingmen" promotes the repair of the injured nerve in the spinal anterior horn probably through inhibiting GluR1 expression in the spinal injured area in the rats with acute SCI.

Effects of endoscopic reprocessing on disinfection and its influential factors during coronavirus disease 2019 pandemic / 中华消化内镜杂志

Objective:To explore the effects of endoscopic reprocessing on disinfection and its influential factors under the coronavirus disease 2019 (COVID-19) pandemic.Methods:A total of 450 endoscopes cleaned and disinfected according to Technical Specifications for Cleaning and Disinfection of Endoscopes from November 2019 to January 2020, and 450 endoscopes cleaned and disinfected according to The recommended procedure for cleaning and disinfection of gastrointestinal endoscopes during COVID-19 epidemic by Chinese Society of Digestive Endoscopology from February to April 2020 in the Second Affiliated Hospital of Chongqing Medical University were enrolled in the control group and observation group respectively by random number method. Both the control group and the observation group contained 200 gastroscopes, 200 enteroscopes and 50 ultrasound endoscopes. ATP fluorescence detection method and pour plate technique were used to evaluate the disinfection effect of endoscopes. Single factor analysis and multiple logistic regression were used to analyze the risk factors for unqualified sterilization after endoscopic reprocessing. Results:The disinfection pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were not significantly different compared with those of the control group ( P>0.05). The sterilization pass rates and ATP test pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were significantly higher than those in the control group (all P<0.05). Multivariate logistic regression analysis showed that non-strict implementation of endoscopic reprocessing ( OR=7.96, 95% CI: 4.55-22.84, P<0.001), non-standard operation ( OR=2.26, 95% CI: 1.24-5.63, P<0.001), insufficient concentration of disinfectant ( OR=5.43, 95% CI: 2.52-9.02, P<0.001), insufficient concentration ratio of multi-enzyme solution ( OR=4.38, 95% CI: 1.95-8.61, P<0.001), non-timely cleaning ( OR=2.86, 95% CI: 1.33-6.42, P<0.001), incomplete cleaning ( OR=3.75, 95% CI: 1.61-7.49, P<0.001) and improper endoscopic preservation ( OR=2.12, 95% CI: 1.36-4.12, P<0.001) were independent risk factors for unqualified sterilization after endoscopic reprocessing. Conclusion:In COVID-19 pandemic, endoscope reprocessing can significantly improve the disinfection effect of endoscopes, worthy of further clinical promotion. The failure to strictly implement the reprocessing procedure is an important factor that may lead to unqualified sterilization.

Clinical efficacy of docetaxel combined with carboplatin in patients with metastatic castration-resistant prostate cancer / 北京大学学报(医学版)

OBJECTIVE@#To observe the early efficacy and toxicity of docetaxel combined with carboplatin in patients with metastatic castration-resistant prostate cancer (mCRPC).@*METHODS@#From May 2017 to July 2019, fifteen patients with mCRPC treated in Peking University First Hospital were collected. The median age was 70 years (43-77 years), and the pathological types were all adenocarcinoma, which was confirmed as distant metastasis by imaging examination. They were given the chemotherapy of docetaxel combined with carboplatin. The specific method was as follows: each cycle was 28 days. Androgen deprivation therapy was administered routinely throughout the treatment period. Blood routine, liver and kidney function, blood clotting function and prostate-specific antigen (PSA) tests were performed before each cycle. Docetaxel was administered intravenously on the first day of each cycle at a dose of 75 mg/m2, and carboplatin was administered intravenously on the second day at the dose calculated by Calvert formula. The main outcome measures including PSA decline range, pain remission rate and occurrence of adverse reactions were observed and analyzed.@*RESULTS@#Among the 15 patients, 12 had completed at least 4 cycles of chemotherapy and had short-term efficacy evaluation. PSA decline range > 50% was observed in 8 patients (66.7%). Among the 9 patients with bone pain, remarkable pain relief was observed in 4 patients (44.4%). Among the 4 patients with measurable metastatic lesions, 2 achieved partial response, 1 was evaluated as stable disease, and 1 was evaluated as progressive disease. The main adverse reactions of chemotherapy included bone marrow suppression, gastrointestinal reactions, fatigue and neurological disorders, and most of them were within the tolerable range.@*CONCLUSION@#This report is a case series study of docetaxel combined with carboplatin in the treatment of mCRPC reported in China and the conclusions are representative. The chemotherapy of docetaxel combined with carboplatin has positive short-term efficacy and high safety in patients with mCRPC, which is worthy of further promotion and exploration in clinical practice.

One-stage surgery in patients with both cardiac and non-cardiac diseases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery.@*METHODS@#From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases.@*RESULTS@#Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia.@*CONCLUSION@#One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.

Research progress on long non-coding RNA (lncRNA) in osteoarthritis / 中国骨伤

Osteoarthritis(OA) is a common clinical disease. The incidence of OA increases significantly with age, and the quality of life of patients is seriously affected. In the pathogenesis of OA, cartilage degeneration is the main cause. There are many long non-coding RNA (lncRNA) specifically expressed in osteoarthritis, which is closely related to the occurrence and development of osteoarthritis. Based on the latest research from 2014 to 2019, this paper summarizes the differential expression of lncRNA in osteoarthritis, the mechanism of lncRNA regulating chondrocyte function, and the mechanism of lncRNA regulating cartilage matrix metabolism. The fact that the expression of lncRNA is altered at different stages of OA development indicates that lncRNA can be developed forlife. The biomarkers and therapeutic targets can provide reference for the prevention, treatment and research of osteoarthritis.

Treatment of dislocation of acromioclavicular joint with TightRope fixation through a small incision in the base of coracoid process / 中国骨伤

OBJECTIVE@#To explore the method and effect of small incision TightRope fixation in the treatment of fresh acromioclavicular joint dislocation.@*METHODS@#From January 2016 to May 2018, 28 cases of fresh acromioclavicular dislocation were treated, including 20 males and 8 females, aged 26 to 87 years with an average age of 51.3 years. The modified Rockwood classification included 1 case of typeⅡ, 22 cases of typeⅢand 4 cases of type V. The average time from injury to operation was 2.4 days. The operative time, shoulder function recovery time and postoperative complications were recorded, and the immediate reduction effect and Karlsson function of shoulder joint were evaluated.@*RESULTS@#In 28 patients, only one Rockwood typeⅡ was used to reconstruct the pyramidal ligament, and the other 27 were used to reconstruct the pyramidal ligament and the trapezoid ligament. The average operation time was (66.50±12.62) min (including intraoperative fluoroscopy time). Twenty-eight cases were followed up for 11 to 20 (16.7±4.6) months. The recovery time of shoulder function was 2 to 7 months with an average of 4 months. During the follow-up period, 1 case had osteolysis and loss of reduction at the clavicular plate site, and the rest had no complications such as re-dislocation and button plate prolapse. Immediate reduction effect after operation:6 cases with reduction insufficiency, 17 cases with complete reduction and 5 cases with excessive reduction;Karlsson function evaluation of shoulder joint in the last follow-up:excellent in 21 cases, good in 6 cases and poor in 1 case;Pearson analysis =0.060, suggesting that the immediate reduction effect of fresh acromioclavicular dislocation operation has no significant correlation with Karlsson function evaluationof shoulder joint in the last follow-up.@*CONCLUSION@#TightRope fixation through a small incision in the base of coracoid process is a simple and effective method for the treatment of dislocation of acromioclavicular joint. There was no significant correlation between the slight difference of immediate reduction effect within 5 mm and Karlsson function evaluation of shoulder joint in the last follow-up. It is suggested to pay attention to the loss of reduction and osteolysis of clavicular plate in clinical follow-up.

A clinical analysis of 14 cases of prostatic stromal tumor of uncertain malignant potential / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical and pathologic characteristics, diagnosis, treatment, prognosis and survival of prostatic stromal tumor of uncertain malignant potential.@*METHODS@#Overall 14 patients with prostatic stromal tumor of uncertain malignant potential were treated from October 2008 to April 2020, the patient age ranged from 27 to 78 years (mean 54 years). The disease duration was 1 to 180 months (mean duration of 46 months). The clinical manifestations mainly included urinary obstructive symptoms and urethral irritating symptoms. The tumors were located in the peripheral zone or the transition zone. Digital rectum examination indicated prostatic tumor. Serum prostatic specific antigen level was always normal or elevated. Transrectal ultrasonography and magnetic resonance imaging indicated prostatic tumor. Magnetic resonance imaging in showed large, round, well-defined masses, which were diffusely heterogeneous signal on T2 weighted imaging. Following the administration of intravenous contrast medium, the lesion had diffuse and heterogeneous enhancement.@*RESULTS@#In the study, 3 cases underwent prostate biopsy, 2 cases underwent transurethral resection of the prostate, 9 cases underwent radical excision or transurethral resection of the prostate with definite diagnosis of pathologic features. Under the light microscope, the interstitial cells of stromal tumor of uncertain malignant potential were overgrowth and fusiform cells showed some degree of pleomorphism, nuclei with few mitotic figures, and necrosis was not often seen. Immunohistochemical staining showed that prostate specific antigen was negative, while vimentin was positive in the tumor tissue, CD34, progesterone receptor and smooth muscle actin were positive in the majority, and Ki67 positive index was 1%-20% (mean 6%). Twelve cases were followed-up, and the time of survival varied from 10 to 96 months (mean 65 months), two cases were lost to the follow-up, one case died of disease at the end of 10 months, nine cases were free of disease recurrence after surgery, two cases underwent more transurethral resection of the prostate due to local recurrence.@*CONCLUSION@#STUMP is a very rare tumor of the specialized prostatic stroma with an unpredictable clinical behavior. The clinical manifestations, transrectal ultrasonography and magnetic resonance imaging are valuable for the diagnosis of prostatic stromal tumor of uncertain malignant potential. Its definite diagnosis depends on pathological examination. Up to now, early surgery and combined therapy are effective treatments for prostatic stromal tumor of uncertain malignant potential.

Evaluating inferior vena cava wall invasion in renal cell carcinoma tumor thrombus with MRI / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the diagnostic performance of MRI for the assessment of inferior vena cava (IVC) wall invasion by IVC thrombus in patients with renal cell carcinoma (RCC).@*METHODS@#We retrospectively collected patients who underwent radical nephrectomy and thrombectomy for RCC between 2010 and 2018 at Peking University First Hospital. All the patients underwent imaging on a 1.5 Tesla or 3.0 Tesla MRI scanner. Fifty-six patients met the inclusion criteria. Preoperative imaging was reviewed by two radiologists blinded to details of the patient's surgical procedure and histopathology. Two radiologists measured the maximum anterior-posterior diameter and coronal diameters of the IVC and renal vein, and the craniocaudal extent of tumor thrombus, and evaluated the MRI features of IVC thrombus, including occlusion of the IVC lumen, the margin of the tumor thrombus (smooth vs. irregular), contact of the IVC thrombus and IVC wall, and altered signal of the IVC wall. Univariable and multivariable associations of clinical and radiographic features with IVC wall invasion were evaluated by Logistic regression.@*RESULTS@#Of the 56 patients [male: 43, female: 13, mean age: (55.64±0.43) years], 17 (30.36%) were detected with IVC wall invasion, and most were clear cell carcinoma. Tumor thrombus with IVC wall invasion showed an increase in length of IVC thrombus [(7.91±3.59) cm vs. (5.94±3.57) cm, P=0.049], and more features of complete occlusion of the IVC lumen (P=0.002), irregular margin of the IVC thrombs (P=0.005), contact of the IVC thrombus and IVC wall (P=0.001), and altered signal of the low-intensity vessel wall (P<0.001), with a sensitivity of 94.12% and a specificity of 79.49%.@*CONCLUSION@#The present study indicates that MRI could be a means of evaluating RCC with IVC wall invasion, and the combination of tumor thrombus length and subjective impression of IVC wall invasion achieved a high sensitivity and specificity for diagnosis.

Clinicopathologic features and prognostic analyses of locally recurrent renal cell carcinoma patients after initial surgery / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinicopathologic features and potential prognostic predictors of locally recurrent renal cell carcinoma patients after initial surgery.@*METHODS@#Authors retrospectively analyzed data extracted from 81 patients who were treated for postoperative locally recurrence of renal cell carcinoma from January 2006 to June 2016 in the Department of Urology, Peking University First Hospital. Postoperative locally recurrence of renal cell carcinoma was defined as disease recurring in the remnant kidney, renal fossa, adjacent abdomen, ipsilateral adrenal and retroperitoneal lymph nodes.@*RESULTS@#In the study, 81 patients were finally included, of whom 43 were initially treated in our hospital and 38 were initially treat in other centers. Partial nephrectomy (PN) was performed for 38 cases (26 in our hospital and 12 in other hospitals) as initial treatment and radical nephrectomy (RN) was conducted for the remnant 43 cases (17 in our hospital and 26 in other hospitals). Overall median recurrence time was 26 months (range: 3-164 months), in which 26 months (range: 3-55 months) for PN cases and 30 months (range: 4-164 months) for RN cases (P=0.009). Sixty-nine patients had single site recurrence, including remnant kidney (n=29), renal fossa (n=20), abdomen (n=4), ipsilateral lymph nodes (n=5), ipsilateral adrenal (n=11), while 12 patients had multiple sites recurrence. Seventy-eight patients were managed by complete surgical resection, while three patients were managed by radiofrequency ablation. Postoperative pathological diagnoses included clear cell carcinoma (n=72), papillary renal cell carcinoma (n=8, 7 cases with type 1, 1 case with type 2) and Xp11 translocation/TFE3 gene fusion renal cell carcinoma (n=1). Complete pathologic information of the initial surgery could be extracted from 43 patients who were initially treated in our hospital. Seventeen patients with initial radical nephrectomy were staged as T1a (n=4), T1b (n=2), T2a (n=1), T3a (n=8), and T3b (n=2). Twenty-six patients with initial partial nephrectomy were staged as T1a (n=18), T1b (n=7), and T3a (n=1). For PN cohort, the patients with T1a stage disease had longer median recurrence time than those with beyond T1a stage disease, and the difference was significant (29 months vs. 18 months, P=0.041). At the end of the follow-up, 58 patients were alive, 4 died and 19 lost the follow-up. Overall, 3-year and 5-year disease free survival rates were 81.9%, and 53.6%, respectively.@*CONCLUSION@#The present research reported a large-scale single central experience of locally recurrent renal cell carcinoma. The recurrence time of the PN group is shorter than that of the RN group. For patients after PN surgery, median recurrence time is longer for patients with T1a stage tumor when compared with those with stage beyond T1a. Patients can obtain relative long-term survival after complete secondary surgery resection.

Evidence-based medicine research on low-back pain with sham-acupuncture controlled design and the analysis on dynamic acupoint positioning / 中国针灸

To explore the positioning of acupoints, a research was done with PubMed for system reviews and clinical trials on treatment of low-back pain with sham-acupuncture controlled design from January 1, 2010 to October 27, 2017. Six system reviews and 12 sham-controlled acupuncture random trials were found. The statistical difference was not found in all the 6 trials with standard acupoint compared with the sham-acupuncture among the 8 penetrating skin sham-control trials. The statistical difference was found in the two trials with penetrating skin sham control, who was used individualized treatment, twirling for arrival or palpation for point. It is considered that sham-acupuncture penetrating skin is not a placebo, and needling with standard or dynamic acupoint may reduce low-back pain, and dynamic acupoint positioning may be better than standard acupoint positioning.

Effects of hypoxic exosomes on the proliferation, migration and invasion of hepatocellular carcinoma Huh7 cells / 中华肝脏病杂志

Objective@#To explore the effects of hypoxic exosomes secreted from hepatocellular carcinoma Huh7 cells on the proliferation, migration and invasion under co-cultured normoxic condition.@*Methods@#Hypoxic exosomes secreted from Huh7 cells under hypoxic conditions were extracted by differential ultracentrifugation. Transmission electron microscopy, nanoparticles tracking analysis and western blot were used for the identification of hypoxic exosomes. Hypoxic exosomes were co-cultured with Huh7 cells under normoxic conditions. CCK8, cell scratch and transwell assay were used to detect the changes of cell proliferation, migration and invasion. Statistical analysis was performed by one-way ANOVA and t-test.@*Results@#Hypoxic exosomes secreted from Huh7 cells ranged in size from 30 to 150 nm in diameter, and expressed exosome surface markers CD9, CD63 and TSG101. Hypoxic exosomes significantly enhanced the proliferation of normoxic Huh7 cells (A value of hypoxic exosomes and control group at 48 and 72 h were 2.131 ± 0.092 and 1.760 ± 0.104,t= 3.740,P<0.01, 3.121 ± 0.157 and 2.298 ± 0.085,t= 8.289,P< 0.01). The migration distance between hypoxic exosome and control group at 48 and 72 h were (0.37 ± 0.06 cm)and(0.19 ± 0.05 cm),t= 4.813,P< 0.05, (1.15 ± 0.07 cm) and(0.62 ± 0.08 cm),t= 8.874,P< 0.05, and invasion ability [hypoxic exosomes and control group were (123 ± 18), (44 ± 12),t= 6.203,P< 0.01].@*Conclusion@#Hypoxic exosomes secreted from hepatocellular carcinoma Huh7 cells can promote cell proliferation, migration and invasion in hypoxic environment, suggesting that intercellular information transmission mediated by hypoxic exosomes may be one of the key mechanisms for the amplification of malignancy of hepatocellular carcinoma cells in hypoxic microenvironment.

Application of multi-slice spiral CT to assess vascular volume for the diagnosis and treatment of gastric varices / 中华肝脏病杂志

Objective@#To differentiate the inflow and outflow channels of gastric varices in cirrhotic portal hypertension patients using multi-slice spiral CT (MSCT), and to assess the relationship between calculable CT volume of gastric varices and the amount of tissue adhesive.@*Methods@#97 cases with cirrhotic gastric varices who were admitted from November 2013 to August 2017 were selected. The type and shape of gastric varices were observed before tissue glue injection treatment by MSCT. The correlation between CT volume of gastric varices and the amount of tissue adhesive was evaluated by Spearman rank correlation coefficient and Univariate linear regression analysis.@*Results@#MSCT showed that Le, g type had the highest proportion (54.6%), followed by Le, g, Lg (20.6%). Le, Lg and Lgf type accounted for 17.5%, and 5.2%, respectively, while Lgf+b accounted for 2.1%. On MSCT, varices of the gastric fundus were in the direction from bottom to top, and 75% of the fundus had a large curved side varices combined with gastric and renal shunt. Under the gastroscopy, varices in the small curved side of the gastric fundus from near to far were formless. In addition, varices in the large curved side of the gastric fundus when observed from different angles to the direction of blood flow (reverse gastroscope) were 72.7% (near and far) or 20.5 % (far and near). There was a positive correlation between CT volume (R = 0.97, P < 0.001) and the amount of tissue adhesive (Y1 = 0.35 + 0.65X1, Univariate linear regression equation; ρ = 0.89, P < 0.001, Spearman correlation analysis).@*Conclusion@#MSCT can recognize the vascular shape and inflow and outflow channels of gastric varices. A positive correlation between CT volume and the amount of tissue adhesive, suggested that the CT volume measurement before treatment could be used as one of the method to predict the amount of tissue adhesive.

Expression of BRCA1 in sporadic invasive breast cancer and its significance / 医学研究生学报

Objective　BRCA1 is one of the most important susceptibility genes of breast cancer. The article aimed to investigate the expression of BRCA1 and its correlation in sporadic invasive breast cancer.　Methods　The expressions of BRCA1, ER, PR, HER2 and Ki67 in 618 cases of sporadic invasive breast cancer in our hospital from January 2015 to December 2017 were detected with immunohistochemistry in order to investigate and analyze the expression of BRCA1 and its correlation with molecular classification, histological type and other related molecular markers in sporadic invasive breast cancer.　Results　The positive rate of BRCA1 was 44.2% consisting of 30.3% weak positive(+) and 13.9% strong positive(++). The positive rates of ER, PR, and HER2 are 60.8%, 54.7%,and 24.9%. The proliferation index ≤30% of Ki67 was 70.7%, >30% was 29.3%. The expression of BRCA1 in luminal type A was significantly lower than the other four types of sporadic invasive breast cancer(P<0.05). The expression of BRCA1 in breast cancer with medullary histological features was significantly lower than those of the other types of breast cancer(P<0.05). There was significant difference between the expression of BRCA1 and the expressions of ER, HER2 and Ki67 (P<0.01). The expression of BRCA1 had positive correlation with expression of HER2 in sporadic invasive breast cancer (r=0.117,P<0.01).　Conclusion　The expression of BRCA1 in sporadic invasive breast cancer with triple negative subtype and medullary histological features is down-regulated and BRCA1 may affect the development and progression of sporadic invasive breast cancer.

Influence of thread shapes of custommade root-analogue implants on stress distribution of peri-implant bone: A three-dimensional finite element analysis / 北京大学学报(医学版)

OBJECTIVE@#To explore the effects from the thread shapes of custom-made root-analogue implant (RAI) on distributions of von Mises stress around the peri-implant bone.@*METHODS@#Five one-stage RAI three-dimensional finite element (FE) models with different thread shapes (V-shaped design, square design, buttress design, reverse buttress design and none thread design) and congruent bone were created through reverse engineering technology. The data of the five models were imported into the FE analysis software to calculate. A force of 100 N was applied parallelly and of 45° to the implant axis respectively. Analysis was performed to evaluate the von Mises stress distributions at the peri-implant regions with the help of the Ansys 16 software.@*RESULTS@#The von Mises stresses distributed mostly at the implant cervical regions and the tip ends of the threads on the cortical bone under oblique loading, while on the cancellous bone, the stresses concentrated mostly on the implant lateral cervical regions, the tip ends of the threads and the apical regions. When under vertical loading, the von Mises stresses distributed mostly at the implant cervical regions on the cortical bone while at the tip ends of the threads and the lateral apical regions on the cancellous bone. The von Mises stresses were better distributed on the thread groups under both kinds of loadings compared with no thread design. But there was no obvious difference among the different thread groups. The concentrations of the von Mises stresses on the cancellous bone in the thread groups were mostly at the tip ends of the threads while less in the apical area. The von Mises stresses were better distributed on the cancellous bone on the other three thread designs than on square design.@*CONCLUSION@#Thread designs are advocated for the reason that adding thread designs to the RAI standard design will have a positive effect on stress distributions at the peri-implant regions and it will reduce the concentrations of von Mises stresses on the cortical bone. From the standpoint of the stress distribution, V-shaped design, buttress design and reverse buttress design are more suitable for RAI than square design. There is no difference of the distributions of the von Mises stresses in the RAI between different thread designs.

Tea polyphenols delays human glomerular mesangial cells senescence induced by high glucose via regulating STAT3/miR-126/telomere signaling pathway activation / 中国中药杂志

The aim of this paper was to explore the effects and possible mechanisms in vitro of tea polyphenols (TP) delaying human glomerular mesangial cells (HGMCs) senescence induced by high glucose (HG). HGMCs were cultured in vitro and divided into the normal group (N, 5.5 mmol·L⁻¹ glucose), the mannitol group(MNT, 5.5 mmol·L⁻¹ glucose plus 24.5 mmol·L⁻¹ mannitol), the high dose of D-glucose group (HG, 30 mmol·L⁻¹ glucose), the low dose of TP group (L-TP, 30 mmol·L⁻¹ glucose plus 5 mg·L⁻¹ TP) and the high dose of TP group (H-TP, 30 mmol·L⁻¹ glucose plus 20 mg·L⁻¹ TP), which were cultured in 5% CO₂ at 37 °C, respectively. Firstly, the effects of TP on the cell morphology of HGMCs were observed after 72 h-intervention. Secondly, the cell cycle, the positive rate of senescence-associated-β-galactosidase (SA-β-gal) staining and the telomere length were detected, respectively. Finally, the protein expressions of p53, p21 and Rb in the p53-p21-Rb signaling pathway were investigated, respectively. And the expressions of p-STAT3 and miR-126 were examined severally. The results indicated that HG not only arrested the cell cycle in G₁ phase but also increased the positive rate of SA-β-gal staining, and shortened the telomere length. HG led to the protein over-expressions of p53, p21 and Rb and HGMCs senescence by activating the p53-p21-Rb signaling pathway. In addition, L-TP delayed HGMCs senescence by improving the cell cycle G₁ arrest, reducing SA-β-gal staining positive rate and lengthening the telomere length. L-TP reduced the protein over-expressions of p53, P21 and Rb induced by HG and inhibited the telomere-p53-p21-Rb signaling pathway. Moreover, the expression of p-STAT3 was increased and the expression of miR-126 was decreased in HGMCs induced by HG. L-TP reduced the expression of p-STAT3 and increased the expression of miR-126 in HGMCs. In conclusion, HG could induce HGMCs senescence by activating the telomere-p53-p21-Rb signaling pathway in vitro. L-TP could delay HGMCs senescence through regulating STAT3/miR-126 expressions and inhibiting the telomere-p53-p21-Rb signaling pathway activation. These findings could provide the effective interventions in clinic for preventing and treating renal cell senescence in diabetic kidney disease.