Assessment of nutritional status in obese patients prior to bariatric surgery / 国际外科学杂志

Objective:To assess the nutritional status of obese patients prior to bariatric surgery, and to explore the related factors of nutrient deficiency.Methods:Clinical data of 43 patients with obesity who underwent bariatric surgery at Beijing Hospital from Jan. 2011 to Dec. 2017 were retrospectively analyzed. Gender, age, BMI, body composition analysis data, blood test data of nutrients were collected. The software of SPSS 20.0 was used to conduct data analysis.Results:Nutrients deficiencies were found for vitamin D (100.0%), iron (26.1%), prealbumin (15.4%) and hemoglobin (7.0%). Hemoglobin, prealbumin, and serum iron levels were significantly higher in male patients than in female patients ( P=0.001, 0.000 and 0.001, respectively). Body fat percentage was negatively correlated with 25 hydroxyvitamin D ( r=-0.983, P=0.017), and positively correlated with serum sodium ( r=0.568, P<0.001). Conclusions:Obesity patients were presented with a variety of nutritional deficiencies before bariatric surgery. A comprehensive nutrients test should be performed before bariatric surgery, to detect and correct nutrient deficiencies preoperatively.

Effects of different doses of dexmedetomidine infused at nighttime on early postoperative cognitive dysfunction in elderly patients undergoing radical resection of malignant gastrointestinal tumors / 中华麻醉学杂志

Objective:To evaluate the effects of different doses of dexmedetomidine infused at nighttime on early postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of malignant gastrointestinal tumors.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of either sex, aged 65-75 yr, with body mass index of 18-24 kg/m 2, scheduled for elective radical resection of malignant gastrointestinal tumors, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C) and different doses of dexmedetomidine groups (D 1-3 groups). Dexmedetomidine 0.1, 0.2 and 0.3 μg·kg -1·h -1 (infusion rate 4 ml/h) were intravenously infused from 21: 00 on the day of surgery and the first day after surgery until 6: 00 in the next morning.Normal saline was given instead of dexmedetomidine in group C. The period of sleep and the number of awakening at night were recorded before surgery and at 2 and 7 days after surgery.Cognitive function was assessed at 1 day before surgery and 7 days after surgery.The concentrations of plasma cortisol were measured at 16: 00 before surgery and 2 and 7 days after surgery and at 8: 00 in the corresponding morning of the next day.The difference in the plasma cortisol concentration measured at 8: 00 every day and at 16: 00 of the previous day were calculated. Results:The incidence of POCD was significantly lower in D 2, 3 groups than in group C ( P<0.05). The number of awakening at night was significantly decreased at 2 days after surgery in group D 3 as compared with the other three groups ( P<0.05). The difference in the plasma cortisol concentration was significantly decreased at 2 and 7 days after surgery in D 2, 3 groups when compared with group C and group D 1 ( P<0.05). Compared with group D 2, no significant change was found in the difference in the plasma cortisol concentration at each time point in group D 3 ( P>0.05). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and tachycardia among the four groups ( P>0.05). Conclusion:Infusing dexmedetomidine 0.2 or 0.3 μg·kg -1·h -1 at the nighttime can reduce the development of POCD in the elderly patients undergoing radical resection of malignant gastrointestinal tumors.

Clinical analysis of prenatal diagnosis and intervention for primary pleural effusion of 13 cases / 中华妇产科杂志

Objective To optimize the clinical managements of primary fetal hydrothorax(PFHT) fetus by comparing the perinatal survival rate of different prenatal treatments.Methods Totally 13 fetuses diagnosed with PFHT from July 2009 to December 2015 in the First Affiliated Hospital of Jinan University were collected and received prenatal expectant treatment, thoracocentesis (TC), and thoraco-amniotic shunting (TAS), respectively. The perinatal survival rate was compared among the three treatments. Results Among 13 fetuses of PFHT,pleural effusion was absorbed or remained stable in 2(2/13)cases,and progressed in 11(11/13) cases. Six cases received expectant treatment (2 cases had termination of pregnancy due to progressing effusion, 2 cases had term delivery, and 2 cases had intrauterine death); the perinatal survival rate was 2/6. Six cases received TC (2 cases had term delivery, 2 cases had preterm delivery,and 2 cases had termination of pregnancy due to progressing effusion),the perinatal survival rate was 4/6.One case received TC+TAS(term delivery),the perinatal survival rate was 1/1.The overall perinatal survival rate of prenatal intrauterine intervention was 5/7. Conclusions The clinical process of PFHT is changeable, and the pleural effusion will progress with gestational age. Intrauterine interventions could improve the perinatal survival rate.

Genetic study of a fetus with 9p direct duplication deletion syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To use next generation sequencing (NGS) to identify unknown abnormality of chromosome 9 in a fetus and explore its mechanism.</p><p><b>METHODS</b>A pregnant woman with abnormal fetal ultrasound finding underwent amniocentesis for G-banded chromosomal analysis. Karyotyping was also performed on peripheral blood samples derived from its parents. Fetal blood sample was obtained for NGS testing to identify abnormality unrecognized by karyotyping.</p><p><b>RESULTS</b>Analysis of amniocytes has revealed a 46,XX,der(9)(?::p21 to qter) karyotype, while both parents had a normal karyotype. NGS analysis of the fetus revealed a 20.67 Mb duplication (4 454 279-25 126 275) at 9p21.3p24.2, which overlapped with that of the 9p duplication syndrome, and a 4.43 Mb deletion at 9p24.2p24.3 (10 001-4 442 364), which partially overlapped with that of 9p deletion syndrome and 46,XY sex reversal 4 region. Comparison of the sequencing data with reference genome database indicated direct duplication of 9p21.3p24.2, which was also supported by review of the morphology of chromosome 9p. Therefore, the karyotype of the fetus was verified to be 46,XX,der(9) dir dup(9)(p21.3p24.2), del(9)(p24.2p24.3).</p><p><b>CONCLUSION</b>Combined G-banded karyotyping and NGS can identify dir dup del(9p) with accuracy. Delineation of the mechanism of dir dup del(9p) and its genotype-phenotype correlation may facilitate genetic counseling and estimation of recurrence risk.</p>

Clinical efficacy of bariatric surgery for elderly and nonelderly obese patients: a Meta analysis / 中华消化外科杂志

Objective To systematically evaluate the clinical efficacy of bariatric surgery for elderly (age ≥ 60 years) or nonelderly (age ＜60 years) obese patients.Methods Literatures were researched using PubMed,Embase,Cochrane Library from January 2006 to June 2016 with the key words including bariatric surgery,metabolic surgery,gastric bypass,gastric band,sleeve gastrectomy,biliopancreatic diversion,elderly,aged,over 60 years.The cohort study about clinical efficacy of bariatric surgery for elderly or nonelderly obese patients were received and enrolled,and surgical procedures were unrestricted.Patients with age ≥ 60 years and with age ＜60 years were respectively allocated into the elderly group and nonelderly group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results Eleven retrospective studies were enrolled in the Meta analysis,and the total sample size was 9 913 patients,including 792 in the elderly group and 9121 in the nonelderly group.The results of Meta analysis showed that there were no statistically significant differences in the early mortality,incidence of postoperative early complication,remission rates of postoperative diabetes,postoperative hypertension,dyslipidemia and obstructive sleep apnea syndrome between elderly group and nonelderly group (OR =3.31,1.94,1.00,0.61,0.99,1.40,95 ％ CI:0.86-12.77,1.01-3.74,0.66-1.50,0.34-1.10,0.42-2.29,0.72-2.72,P＞0.05).Conclusion The safety and clinical efficacy of bariatric surgery in the elderly obese patients are equivalent to that of nonelderly patients.

Improved identification for 5p deletion syndrome and partial trisomy 11q presented in a fetus by SNP array / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the prenatal application of single nucleotide polymorphism array (SNP array) in the identification of 5p deletion syndrome with partial trisomy 11q.</p><p><b>METHODS</b>G-banded karyotyping and SNP array were performed using amniocytes on a fetus with multiple malformations for the identification of chromosome abnormality. Furthermore, karyotyping was carried out on the parental peripheral blood specimens to ascertain the origin of chromosome abnormalities and then fluorescence in situ hybridization (FISH) was also utilized to confirm the results.</p><p><b>RESULTS</b>Karyotype of amniocyte showed 46, XY, der(5) (?::p15 → qter). SNP array revealed a 13.907 Mb deletion at 5p15.33p15.2 (chr5: 113576-14020561), overlapping the region of 5p deletion syndrome, and a 18.254 Mb duplication at 11q23.3 q25 (chr11: 116684627-134938470), overlapping no known syndrome. Karyotype of the parents showed a normal 46,XX in mother and 46,XY,t(5;11)(p15;q23) in father. Three-color metaphase FISH analysis on paternal peripheral blood specimens also confirmed the paternal karyotyping result.</p><p><b>CONCLUSION</b>SNP array could uncover 5p deletion syndrome with partial trisomy 11q unidentified by G-banded karyotyping and accurately locate the genomic breakpoints, facilitating the mapping of pathogenic critical regions and the identification of candidate genes, also accumulating research data for genotype-phenotype study.</p>

Accurate detection of a case with Angelman syndrome (type 1) using SNP array / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze a case with Angelman syndrome (AS) using single nucleotide polymorphism array (SNP array) and explore its genotype-phenotype correlation.</p><p><b>METHODS</b>G-banded karyotyping and SNP array were performed on a child featuring congenital malformations, intellectual disability and developmental delay. Mendelian error checking based on the SNP information was used to delineate the parental origin of detected abnormality. Result of the SNP array was validated with fluorescence in situ hybridization (FISH).</p><p><b>RESULTS</b>The SNP array has detected a 6.053 Mb deletion at 15q11.2q13.1 (22,770,421- 28,823,722) which overlapped with the critical region of AS (type 1). The parents of the child showed no abnormal results for G-banded karyotyping, SNP array and FISH analysis, indicating a de novo origin of the deletion. Mendelian error checking based on the SNP information suggested that the 15q11.2q13.1 deletion was of maternal origin.</p><p><b>CONCLUSION</b>SNP array can accurately define the size, location and parental origin of chromosomal microdeletions, which may facilitate the diagnosis of AS due to 15q11q13 deletion and better understanding of its genotype-phenotype correlation.</p>

Mechanism Analysis of the Antidepressant Effect of Acupuncture by Regulating the HPA Axis / 上海针灸杂志

Studies have found that depression is closely related to the hyperactivity of the hypothalamo–pituitary–adrenal (HPA) axis, which is manifested in increases in HPA axis-related hormones CRH, ACTH and CORT contents. Traditional Chinese medical acupuncture can down-regulate HPA axis levels to produce a marked antidepressant effect. However, at present there is no HPA axis mechanism analysis of the antidepressant effect of acupuncture. From two aspects: the relationship between depression and HPA axis, and clinical and animal mechanism studies of the antidepressant effect of acupuncture by regulating the HPA axis, an analysis has been made to provide a more powerful scientific basis and the idea of further in-depth study for clinical acupuncture treatment of depression.

Myocardial protection of a novel histone deacetylase inhibitor against hypoxia injury / 军事医学

Objective To verify enzyme activity inhibition of a novel histone deacetylase inhibitor ( HDACi ) JZ005 using an HDACi chemiluminescence detection kit and a cell-based screening model .Methods The plasmid with p21 gene promoter elements and luciferase reporter gene was transfected into human embryonic kidney cells 293 , and the stable transfectants were established by G418 screening.Enzyme activity inhibition of JZ005 on histone deacetylases (HDACs) was verified by the HDACi chemiluminescence detection kit and the cell-based screening model .A well-known HDACi , tri-chostatin A ( TSA) was used as the positive control .MTT assay was used to detect the protection of rat H 9c2 myocardial cells suffering from CoCl 2-induced hypoxia and treated with different concentrations of JZ 005 .The expression of acetylated histone H3 protein of normal and CoCl 2-induced hypoxia H9c2 cells before and after JZ005 treatment was assayed by West-ern blotting while the effect of drug administration on apoptosis was detected by flow cytometry ( FCM) .Results An HDA-Ci cell-based screening system targeting the p21 gene promoter was ranging established .The JZ005, a HDACi, markedly suppressed the activity of HDACs by more than 50%with the concentration ranging from 50 to 400 μmol/L.JZ005 signifi-cantly protected H9c2 cells from hypoxia injury .Cell viability was increased by 38.33%,56.00% and 35.20% compared with control,accompanied by an enhanced acetylation level of histone H 3.JZ005(25,50 and 100 μmol/L) treatment sig-nificantly decreased the number of apoptotic cells (6.63%,10.56% and 8.89%) compared to control group (12.89%). Conclusion An HDACi cell-based screening system is successfully established .JZ005 effectively protects myocardial cells against hypoxia injury while enhancing the acetylation level of histone H 3.Our results indicate that JZ005 might be developed as a potential drug for hypoxia treatment .

Genetic abnormality analysis in 169 childhood acute lymphoblastic leukemia and their response to early treatment / 中华实用儿科临床杂志

Objective To explore the common genetic abnormalities in childhood acute lymphoblastic leukemia(ALL) and their responses to early treatment response.Methods From December of 2010 to December of 2011,169 newly diagnosed ALL patients at the Department of Hematology,Beijing Children's Hospital Capital Medical University,were detected by karyotype analysis,reverse transcription polymerase chain reaction (RT-PCR) and fluorescent in situ hybridization (FISH),and the relationship between early treatment responses and genetic abnormalities was observed.Results Of the 169 cases,bone marrow cell specimens from 162 cases were successfully cultured,with the success rate reached to 95.9％,and 88 cases (52.1％) had chromosomal abnormalities.Fifty-five cases carried 8 types of fusion genes among the 153 patients who received RT-PCR examination,and the abnormal rate was 35.9％.Forty cases applied for the detection of mixed lineage leukemia (MLL) gene rearrangement by FISH,and 6 cases of them were positive.One hundred and five cases had genetic abnormalities and the detection rate reached to 62.1％ by using three combined methods.The genetic abnormalities were classified into 6 groups,they were t(12;21),t(1;19),t(9;22),MLL rearrangement,hyperdiploid and-6/6q-,-7/7q-respectively,and early therapy response in each group was compared,and statistically significant differences were found among 6 groups (x2 =22.954,19.432,14.045,P =0.001,0.001,0.016).Conclusions Conventional cytogenetics combined with RT-PCR and FISH can enhance the detection rate of genetic abnormalities in childhood ALL.Genetic abnormalities combined with early treatment response in ALL can better guide the clinical treatment and prognosis assessment.

A novel histone deacetylase inhibitor induces proliferation inhibition of human colon cancer cells / 军事医学

Objective To examine the anticancer effect of a novel histone deacetylase inhibitor (HDACi), JZ004, on colon cancer cells HCT-8 and HT-29, and to investigate the molecular mechanisms of proliferation inhibition and apoptosis induction of cancer cells treated by JZ 004.Methods Colon cancer cells were treated with a series of concentrations of JZ004 .MTT assay was used to detect the proliferation of cancer cells .The cell cycle distribution and apoptosis were deter-mined by flow cytometry .Rhodamine 123 and DCFH-DA were applied to detect the mitochondrial membrane potential (ΔΨm) and reactive oxygen species ( ROS) production.The protein expressions of acetyl-histone H3, p21, cyclin-dependent kinase(CDK)4, Bcl-2, Mcl-1 and Bax were assayed by Western blotting .Results JZ004 was found to inhibit proliferation and induce apoptosis of colon cancer cells in a time-and dose-dependent manner , accompanied by a dose-dependent hyperacetylation of histone H3.JZ004 induced the cancer cell arrest in G 0/G1 phase by increasing the expres-sion level of p21 while CDK4 was downregulated .JZ004 also increased cellular ROS production and reduced ΔΨm by regu-lating the expressions of Bcl-2 family proteins .Conclusion As a novel HDACi , JZ004 effectively inhibits proliferation and increases ROS production to induce apoptosis of colon cancer cells .The results indicate that JZ004 is a potential compound to be developed as an anti-colon cancer agent for clinic application .

Ultrasound soft markers in screening for fetal chromosomal abnormality during first-trimester / 中华围产医学杂志

Objective To investigate the clinical values of multiple ultrasound soft markers in screening for fetal chromosomal abnormality during first-trimester.Methods Two thousand seven hundred and eighty-nine nulliparas in Department of Obstetrics,the First Affiliated Hospital of Jinan University during early pregnancy (11-13+6 gestational weeks) were selected for this study.Fetalnuchal translucency (NT),facial angle (FA),ductus venosus (DV),fetal heart rate (FHR),tricuspid reverse (TR),nasal bone (NB) and fetal structures were scanned and measured.Risk calculation software (Astraia) was used to calculate the chromosomal abnormal risk (cut-off line:＞1/300) based on ultrasound records.The chorionic villi or amniotic fluid of high risk patients was collected with informed consent for karyotype analysis (prenatal diagnosis).All patients were followed up until six months after delivery.Chi-square test or Fisher exact test was used to compare the difference.Results One hundred and seven cases were high-risk of trisomy 21 among which 96 cases accepted invasive prenatal diagnosis.Sixteen chromosomal anomaly and six trisomy 21 cases were diagnosed out the 96 fetuses.Among 2789 cases,four were high-risk of trisomy 21 according to ultrasound screening.Six cases were diagnosed as trisomy 21.The false positive rate of ultrasound screening was 3.6％(101/2783).There were 196 cases whose NT ≥2.5 mm,in which 66 cases were high risk of chromosomal abnormality,and 16 fetal chromosomal abnormalities were diagnosed after chorionic villus sampling.The invasive procedure rate was 2.3％ (66/2789).Totally,186 pregnant women were older than 35 years,among which 32 cases were high risk.There was no significantly difference on the of rate fetal chromosomal abnormality between the groups of age≥ 35 pregnant women and the general population (P=0.055).But 29.9％ (32/107) high risk cases were detected in the group of age≥35.Five of thirteen fetal malformations cases were associated with abnormal karyotype.Conclusions Multiple ultrasound soft markers screening during early pregnancy could increase the diagnosis rate of chromosomal abnormality and decrease the false positive rate,false negative rate and invasive procedure rate.Early ultrasound screening might be effective in not only identifying chromosomal abnormality,but also diagnosing severe structure deformity of fetus.

Relationship between maternal serum alpha-fetoprotein and fetal middle cerebral artery peak systolic velocity in pregnancy with fetal anaemia / 中国病理生理杂志

AIM: To evaluate the relationships between maternal serum alpha-fetoprotein (MSAFP) levels and middle cerebral artery peak systolic velocity (MCA-PSV) in pregnancies with fetal anaemia and to compare the sensitivities of MSAFP and MCA-PSV for the predicting the risk of fetal anaemia. METHODS: Fifty-five measurements of MSAFP and MCA-PSV were carried out in 32 women at risk of fetal anaemia (4 cases of alloimmunisation, 11 cases of thalassemia, 10 cases of parvovirus infection and 7 cases of placental chorioangioma). The relationship between MSAFP and MCA-PSV was studied, and 19 fetal blood samples, in which MCA-PSV measurements were abnormal, were taken and the fetal heamoglobin were tested in order to evaluate the correlation of MSAFP and MCA-PSV. RESULTS: A correlation between MSAFP and MCA-PSV (n=55, r=0.57, P<0.01) was observed, in which 15 cases of fetal anaemia and 4 cases false positive (non-anaemia) were detected among the 19 fetal blood samples. The MSAFP levels of 4 false-positive cases were normal. The MSAFP levels in 15 fetal anaemia cases were higher than those in non-anaemia. The elevation of MSAFP level was 15-20 d earlier than that of MCA-PSV in the cases of alloimmunisation and thalassemia, and it was 10-12 d later in the cases of parvovirus infection and placental chorioangioma significantly (P<0.05). Both MSAFP (r=-0.87) and MCA-PSV (r=-0.67) were significantly correlated with fetal heamoglobin level. CONCLUSION: The MSAFP level is significantly correlated with both MCA-PSV measurements and fetal haemoglobin. The time and process of the elevations of MSAFP indicate that MSAFP is more sensitive than MCA-PSV to predict and monitor the pregnancies at the risk of fetal anaemia.