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OBJECTIVE@#This study aimed to investigate the association of ambient PM2.5 exposure with blood pressure (BP) at the population level in China.@*METHODS@#A total of 14,080 participants who had at least two valid blood pressure records were selected from the China Health and Retirement Longitudinal Survey during 2011-2015. Their long-term PM2.5 exposure was assessed at the geographical level, on the basis of a regular 0.1° × 0.1° grid over China. A mixed-effects regression model was used to assess associations.@*RESULTS@#Each decrease of 10 μg/m3 in the 1 year-mean PM2.5 concentration (FPM1Y) was associated with a decrease of 1.24 [95% confidence interval (CI): 0.84-1.64] mmHg systolic BP (SBP) and 0.50 (95% CI: 0.25-0.75) mmHg diastolic BP (DBP), respectively. A robust association was observed between the long-term decrease in PM2.5 and decreased BP in the middle-aged and older population. Using a generalized additive mixed model, we further found that SBP increased nonlinearly overall with FPM1Y but in an approximately linear range when the FPM1Y concentration was < 70 µg/m3; In contrast, DBP increased approximately linearly without a clear threshold.@*CONCLUSION@#Efficient control of PM2.5 air pollution may promote vascular health in China. Our study provides robust scientific support for making the related air pollution control policies.
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Middle Aged , Humans , Aged , Particulate Matter/analysis , Blood Pressure , Air Pollutants/analysis , Follow-Up Studies , Hypertension/etiology , East Asian People , Environmental Exposure/analysis , Air Pollution/analysis , China/epidemiologyABSTRACT
AIM: To investigate the mechanism of pyrrolidine dithiocarbamate(PDTC)on transforming growth factor-beta 2(TGF-β2)-induced epithelial-mesenchymal transition(EMT)in human lens epithelial cells(LECs).METHODS: LECs were treated with various doses of PDTC chemicals following TGF-β2 caused EMT on these cells. Cell proliferation and lateral migration were discovered using the CCK-8 and cell scratch test. The markers of EMT, including E-cadherin, α-SMA and nuclear factor-κB(NF-κB)signaling pathway-related expression, were tested by Western Blot as well as the changes in the expression of the apoptosis-related proteins BAX, BCL-2, Caspase-3, and Cyclin D1.RESULTS: The proliferation and migration viability of cells in the TGF-β2 treated group was increased compared to the group without TGF-β2, and the expression of α-SMA increased whereas the E-cadherin expression decreased. With the effect of TGF-β2, NF-κB p65 and phosphorylated NF-κB p65 expression increased, the concentration of TGF-β2 that had the greatest capacity for proliferation and migration was 10 ng/mL(P<0.05). Mechanism study of PDTC-induced EMT reversal and apoptosis showed that cell viability and migratory capability were both significantly reduced after PDTC intervention; PDTC prevents IκB phosphorylation, thus inhibiting NF-κB nuclear translocation. Protein associated to the NF-κB signaling pathway, and protein expression of NF-κB/IκBα/p-IκBα/Iκκ-α/p-Iκκ-α was decreased(P<0.05), PDTC increased the expression of the pro-apoptotic protein BAX/Caspase-3, expression of the inhibitor of apoptosis protein BCL-2 and the cell cycle protein Cyclin D1 was reduced. The expression of NF-κB/IκB mRNA was reduced, expression of the apoptosis-related mRNA BAX increased, while BCL-2 reduced.CONCLUSION: The EMT in LECs cells induced by TGF-β2 can be significantly reversed by PDTC, which may be related to the decreased expression of NF-κB p65/IκB/Iκκ-α and activation of apoptosis-related protein. PDTC can reverse EMT by inhibiting NF-κB signaling pathway and induce apoptosis of abnormally proliferated cells, which will provide new potential therapeutic agents for posterior capsular opacification(PCO)treatment.
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OBJECTIVE: To establish a method combining triterpenoids fingerprint with chemometric analysis based on reference drug, and determine 89 batches of samples to evaluate the quality of Ganoderma preparations. METHODS: The samples were extracted by ultrasonic with methanol, chromatography was performed on Agilent TC C18(2) column (4.6 mm×250 mm, 5 μm) with gradient elution with acetonitrile and 0.02% phosphoric acid aqueous solution. The detection wavelength was set at 254 nm. Principal component analysis and HCA heatmap were used for data analysis. RESULTS: The chromatographic fingerprint has 56 characteristic peaks. By comparing the samples with the reference drug, it was found that Ganoderma preparations were produced using Ganoderma lucidum by almost all manufacturers. Principal component analysis, HCA heatmap analysis and similarity analysis divided the samples into three categories. The first type had characteristic peaks and peak areas which were consistent with the reference drug, and the quality was better. The second type had characteristic peaks which consistent with the reference drug, but the peak areas were smaller and the quality was medium. And the third type was different from the reference drug, which was the problem sample. The strong characteristic peaks for classification of different samples were peak 26, peak 31, peak 24, peak 32 and peak 18. CONCLUSION: The method is comprehensive, accurate and specific, and it can be used for comprehensive quality evaluation of triterpenoids in Ganoderma preparations.
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BACKGROUND: We examined changes in hepatitis B core-related antigen (HBcrAg) during the four sequential phases of chronic hepatitis B virus (HBV) infection: hepatitis B e antigen (HBeAg)-positive chronic infection (EPCI) and hepatitis (EPCH), followed by HBeAg-negative chronic infection (ENCI) and hepatitis (ENCH). We compared the performance of serum HBcrAg, hepatitis B surface antigen (HBsAg), and HBV DNA in predicting EPCH and ENCH. METHODS: We enrolled 492 consecutive patients: 49 with EPCI, 243 with EPCH, 101 with ENCI, and 99 with ENCH. HBcrAg was detected by chemiluminescent enzyme immunoassays. HBsAg and HBeAg were detected by chemiluminescent microparticle immunoassays. HBV DNA was detected by real-time PCR. Predictive performance of HBcrAg, HBsAg, and HBV DNA was evaluated using ROC curves. RESULTS: Areas under ROC curves (AUCs) of HBcrAg, HBsAg, and HBV DNA for predicting EPCH were 0.738, 0.812, and 0.717, respectively; optimal cutoffs were ≤1.43×105 kU/mL, ≤1.89×104 IU/mL, and ≤3.97×107 IU/mL, with sensitivities and specificities of 66.3% and 77.6%, 65.0% and 93.9%, and 60.5% and 79.6%, respectively. AUCs of HBcrAg, HBsAg, and HBV DNA for predicting ENCH were 0.887, 0.581, and 0.978, respectively; optimal cutoffs were >26.8 kU/mL, >2.29×102 IU/mL, and >8.75×103 IU/mL, with sensitivities and specificities of 72.7% and 95.1%, 86.9% and 39.6%, and 89.9% and 92.1%, respectively. CONCLUSIONS: HBsAg and HBV DNA were the best predictors of EPCH and ENCH, respectively. HBcrAg is an important surrogate marker for predicting EPCH and ENCH.
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Humans , Area Under Curve , Biomarkers , DNA , Hepatitis B e Antigens , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis B, Chronic , Hepatitis , Hepatitis, Chronic , Immunoassay , Immunoenzyme Techniques , Real-Time Polymerase Chain Reaction , ROC CurveABSTRACT
Objective To compare the predictive capability of multiple linear regression (MLR)and neural network model (NNM) for pulmonary artery obstruction index (PAOI) in pulmonary embolism.Methods One hundred and forty-seven APE patients (79 male,68 female) were collected from March 2015 to July 2016 in our hospital and randomly divided into training group and testing group with the ratio of 3 ∶ 1.Four indexes,including total volume (V),total length (L),total degree of embolism (D) and total number of clots (N) were calculated by computer assisted detection.Qanadli index (Q) as CT PAOI was calculated manually.With SPSS 14.2 modeler,the predictive value of Qanadli index ((Q)) was calculated by MLR and NNM respectively,with Qanadli index as dependent variable and V,L,D,N as independent variables.SPSS 22.0 Spearman test was used to analyze the correlation between (Q) and Q.Mean absolute error (MAE),mean relative error (MRE),root mean square error (RMSE) were used to quantify the accuracies of two methods.Results MLR equation was (Q)=10.98+ 1.37×V+0.06×L,model fitting was 0.764.NNM included one hidden layer and two neurons with accuracy of 0.868.In training group,the correlation between (Q) and Q in NNM (r=0.932,P＜0.01) was higher than MLR (r=0.879,P＜0.01);in testing group,the correlation between (Q) and Q in NNM (r=0.875,P＜0.01) was higher than MLR (r=0.868,P＜0.01).In training group,MAE,MRE and RMSE of NNM (5.144,0.274,6.957) were significantly lower (t=3.402,P=0.002) than MLR (6.784,0.282,8.700);in testing group,MAE,MRE and RMSE of NNM (6.643,0.312,9.195) were significantly lower (t=3.383,P=0.002) than MLR (8.505,0.334,10.361).Conclusion NNM is a better model in predicting CT pulmonary artery obstruction index of APE patients.
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OBJECTIVE: To propose a holistic strategy for quality control of Chinese patent medicines, and establish an HPLC analytical method for Tongzhi Surunjiang preparation according to the strategy. METHODS: The strategy contained three steps.The first step was multi-wavelength chromatographic detection.The second step was multivariate analysis for identification and assay. The third step was to establish substitute reference substance method.The preparations were extracted by ultrasound with methanol, chromatography was performed on ODS column with gradient elution with acetonitrile and 0.1%phosphoric acid aqueous solution.The detection wavelengths were set at 270, 350, 410 and 440 nm.The radar chart, HCA heatmap, principal component analysis and cosine similarity were used for data analysis.At last, linear calibration using two reference substances, relative retention time method and PDA spectrum method were used for peak identification, and relative correction factor method was used for quantitative analysis. RESULTS: The multi-components determination method and fingerprint analysis met the method validation requirements. Data analysis showed that there were some differences among the samples of different manufacturers. Strong characteristic peaks for classification were gallic acid, chebulinic acid, chebulea fructus, sennae folium, sennae folium and crocin.CONCLUSION: The method is specific, with low cost, and could be used to accurately control the quality of Tongzhi Surunjiang preparation.
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This paper reports a severe case of Strongyloides stercoralis infection during routine sputum smear examinations, due to cough and shortness of breath, so as to improve clinicians’ awareness of strongyloidiasis to avoid and reduce misdiagnosis and missed diagnosis.
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Objective To explore the risk factors of complications after laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer (GC).Methods The retrospective case-control study was conducted.The clinicopathological data of 488 GC patients who underwent LADG in the General Hospital of the Chinese People's Liberation Army between January 2010 and May 2016 were collected.Observation indicators:(1)surgical and postoperative situations;(2) risk factors analysis of postoperative complications;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the post-operative survival of patients up to October,2017.Measurement data with normal distribution were represented as (x)±s,and measurement data with skewed distribution were described as M (interquartile range).The univariate analysis was done using the chi-square test (count data),t test (measurement data with normal distrubution and homogeneity of variance) or t'test (measurement data with normal distribution and heterogeneity of variance) and nonparametric test (measurement data with skewed distrubution).The multivariate analysis was done using the Logistic regression model.Results (1) Surgical and postoperative situations:all the 488 patients underwent successful surgery,including 7 with conversion to open surgery due to intraoperative bleeding and difficult surgery and 481 with LADG.The operation time and volume of intraoperative blood loss of 488 patients were (233±71)minutes and 100 mL (100 mL).The postoperative complications occurred in 99 of 488 patients,some patients merged simultaneously multiple complications.The Clavien-Dindo Ⅰ,Ⅱ,Ⅲa,Ⅲb,Ⅳa,Ⅳb and Ⅴ complications were detected in 39,26,26,6,0,0 and 2 patients,respectively.The top 3 postoperative complications were delayed gastric emptying (18 patients),intestinal obstruction (14 patients) and anastomotic fistula (14 patients).Cases with delayed gastric emptying,intestinal obstruction and anastomotic fistula were respectively 12,12,6 with the Clavien-Dindo classification ＜ Ⅲ a and 6,2,8 with the Clavien-Dindo classification ≥ Ⅲ a.Of 99 patients with postoperative complications,97 were improved by symptomatic treatment and 2 died.Duration of postoperative hospital stay was (13± 12)days.(2) Risk factors analysis of postoperative complications:the results of univariate analysis showed that preoperative concomitant diseases and digestive tract reconstruction were the related factors affecting postoperative complications of patients undergoing LADG;(x2 =11.225,6.581,P＜0.05).The results of multivariate analysis showed that preoperative concomitant diseases and Billroth Ⅱ anastomosis were the independent risk factors affecting postoperative complications of patients undergoing LADG (Odds ratio=2.336,2.630,95％ confidence interval:1.475-3.687,1.369-5.053,P＜0.05).(3) Follow-up and survival situations:of 486 discharged patients,380 were followed up for 2-89 months,with a median time of 42 months.During the follow-up,289,35,48 and 8 patients had respectively tumor-free survival,tumor recurrence and/or metastasis,tumor-related death and non-tumor-related death.Conclusion The anastomotic fistula is one of the common and severe complications after LADG,and preoperative concomitant diseases and Billroth Ⅱ anastomosis are the independent risk factors affecting postoperative complications of patients undergoing LADG.
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Objective To study the value of serum human epididymal protein 4 (HE4) ,cytokeratin 19 frag-ment (CYFRA21-1) ,neuron-specific enolase (NES) and gastrin release precursors (Pro-GRP) in the diagnosis of female lung cancer .Methods A total of 100 cases of female lung cancer patients in the hospital were select-ed as the research object ,100 cases of benign lung diseases and 100 female health examiners as the control ,the serum levels of HE4 ,CYFRA21-1 ,NES and Pro-GRP were measured ,and the related statistical analysis was carried out .Results The serum levels of HE4 ,CYFRA21-1 ,NES and Pro-GRP in patients with lung cancer were significantly higher than those of benign lung disease and healthy control group (P<0 .05) ,and there was no significant difference between the benign lung disease group and the healthy control group (P>0 .05) . There was no significant difference in serum HE4 expression in different stages and pathological types of lung cancer (P>0 .05) .The ROC curve analysis showed that the area (AUC) of HE4 ,CYFRA21-1 and NES/Pro-GRP w ere 0 .927 ,0 .758 ,0 .652 and 0 .799 respectively ,and the best critical values w ere 63 .38 ,2 .05 ,14 .05 and 58 .50 respectively ,and the sensitivity was 88 .0％ ,80 .0％ ,60 .0％ ,71 .0％ respectively ,and the speci-ficity was 96 .0％ ,73 .0％ ,87 .0％ and 89 .0％ respectively .HE4 was obviously better than the other 3 items . Combined detection of HE4 ,CYFRA21-1 ,NES and Pro-GRP could also improve the diagnostic sensitivity of lung cancer ,which was 89 .0％ ,but the specificity had decreased by 88 .0％ .Conclusion The level of serum HE4 in female patients with lung cancer is significantly higher ,which can be used as a candidate marker for differential diagnosis of pulmonary benign and malignant diseases .The combined detection of these 4 markers has a high sensitivity for the diagnosis of female lung cancer ,which is suitable for the survey of female lung cancer in clinical .
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<p><b>OBJECTIVE</b>To compare the short-term outcomes between robotic and laparoscopic radical total gastrectomy in gastric cancer patients with BMI index ≥24 kg/m.</p><p><b>METHOD</b>Clinical data of 93 gastric cancer patients who underwent robotic and laparoscopic radical total gastrectomy at PLA General Hospital from April 2016 to April 2017 were retrospectively analyzed. The retrospective cohort study was adopted.</p><p><b>INCLUSION CRITERIA</b>preoperatively definite diagnosis of primary gastric cancer by endoscopy and biopsy; preoperative BMI ≥24 kg/m; no previous abdominal surgery; no previous chemotherapy and radiotherapy; no distant metastasis or invasion into adjacent organs before operation or during operation; receiving radical gastrectomy; Roux-en-Y reconstruction of digestive tract in open procedure. According to approaches of minimally invasive surgery, 24 patients underwent robotic surgery and 69 underwent laparoscopic surgery. The intraoperative parameters (overall operative time, pneumoperitoneal time, open procedure time, intraoperative blood loss, transfusion rate, number of total retrieved lymph nodes and metastatic lymph nodes) and postoperative parameters (drainage in the first postoperative day, the first defecation time, morbidity of postoperative complication and hospital stay) were compared between two groups. Correlation of the above parameters were analyzed.</p><p><b>RESULTS</b>Of 93 patients, 77 were male and 16 female with an average age of (60.0±10.6) years. The average BMI was (26.8±1.3) kg/m in whole patients, (26.9±1.6) kg/m in robotic group and (26.8±1.7) kg/m in laparoscopic group. No significant differences in age, gender, BMI, preoperative ASA class, postoperative pathological findings and clinical classification were observed between two groups, which made short-term parameters between two groups comparable. The robotic group had a significantly longer overall operative time [(301.2±68.9) minutes vs. (247.3±59.6) minutes, P=0.000], longer open procedure time [(141.5±26.3) minutes vs. (92.5±36.7) minutes, P=0.029] and higher cost than laparoscopy group[(17.5×10 ± 9.7×10) yuan vs. (10.0×10 ± 2.3×10) yuan, P=0.001]. Pneumoperitoneal operative time, intraoperative blood loss, transfusion rate, number of total retrieved lymph nodes, number of harvested metastatic lymph nodes and postoperative short-term efficacy were similar between the two groups (all P>0.05). In robotic group, pneumoperitoneal operative time was positively correlated with overall operative time (r=0.708, P=0.010); total cost was positively correlated with postoperative hospital stay (r=0.493, P=0.000) and open procedure time was negatively correlated with the first defecation time (r=-0.962, P=0.038). In laparoscopy group, total cost was positively correlated with overall operative time (r=0.411, P=0.046), drainage volume in the first postoperative day was positively correlated with the number of total dissected lymph node (r=0.540, P=0.006), postoperative hospital stay was positively correlated with intraoperative blood loss (r=0.574, P=0.003), total cost was positively correlated with intraoperative blood loss and hospital stay (r=0.609, P=0.002; r=0.865, P=0.000), drainage volume in the first postoperative day was positively correlated with BMI (r=0.533, P=0.007).</p><p><b>CONCLUSION</b>For gastric cancer patients with BMI ≥24 kg/m, robotic radical total gastrectomy is associated with longer operative time and higher cost, but is less vulnerable to the change of BMI and more in favor of the realization of enhanced recovery after surgery (ERAS) than laparoscopic radical total gastectomy.</p>
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Aged , Female , Humans , Male , Middle Aged , Body Mass Index , Gastrectomy , Methods , Laparoscopy , Length of Stay , Operative Time , Retrospective Studies , Robotic Surgical Procedures , Stomach Neoplasms , General Surgery , Treatment OutcomeABSTRACT
Diabetes has become the third largest killer to human life and health,and its development is closely related to the intestinal flora imbalance caused by series of consequences.So adjusting the structure of intestinal flora becomes a new idea for the treatment of diabetes.Traditional Chinese medicine (TCM) has good curative effect in prevention and treatment of diabetes,and improvement on the structure of intestinal flora may be one of its important mechanisms.The article reviewed the research progress on prevention and treatment of diabetes by TCM single components (berberine,phloridzin,rheinic acid,etc),TCM single prescription (essential oil from Cinnamomum cassia,flower stalk of Coptis chinensis,total coumarin of Feucedani Radix) and TCM priscriptions (Gegen Qinlian Decoction,Shengjiang Powder,Buzhong Yiqi Decoction,Huanglian Jiedu Decoction,Wenyang Yiqi Huoxue Compound,etc.) based on new targets in intestinal flora,so as to provide reference for the development of TCM for prevention and treatment of diabetes.
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Diabetes has become the third largest killer to human life and health,and its development is closely related to the intestinal flora imbalance caused by series of consequences.So adjusting the structure of intestinal flora becomes a new idea for the treatment of diabetes.Traditional Chinese medicine (TCM) has good curative effect in prevention and treatment of diabetes,and improvement on the structure of intestinal flora may be one of its important mechanisms.The article reviewed the research progress on prevention and treatment of diabetes by TCM single components (berberine,phloridzin,rheinic acid,etc),TCM single prescription (essential oil from Cinnamomum cassia,flower stalk of Coptis chinensis,total coumarin of Feucedani Radix) and TCM priscriptions (Gegen Qinlian Decoction,Shengjiang Powder,Buzhong Yiqi Decoction,Huanglian Jiedu Decoction,Wenyang Yiqi Huoxue Compound,etc.) based on new targets in intestinal flora,so as to provide reference for the development of TCM for prevention and treatment of diabetes.
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Objective To explore the association between exposure to ambient air pollution during pregnancy and congenital heart disease so as to provide evidence for primary prevention of congenital heart disease.Methods Epidemiologic studies on ambient air pollution and congenital heart diseases were reviewed.Summary risk estimates were calculated at high versus low exposure levels and risk per-unit-increase in continuous pollutant concentration.Meta-analysis was conducted with Stata 12.0 software.Results A total of 20 articles in English were qualified for inclusion.Results from Meta-analysis showed that CO exposures were related to the increase on the risk of tetralogy of fallot (high versus low exposure level OR=1.22,95％CI:1.03-1.44),while the exposures to NO2 were related to the increase on risk of coarctation of aorta (per 10 mm3/m3 OR=1.01,95％CI:1.01-1.20).Exposures to O3 were related to the increase on risk of atrial septal defect (per 10 mm3/m3 OR=1.14,95％CI:1.03-1.26),and PM10 exposures were related to the increase on risk of atrial septal defect (per 10 μg/m3 OR=1.10,95％CI:1.03-1.19).In addition,there were inverse associations between CO and atrial septal defect and between PM10 and ventricular septal defect.Conclusion Exposures to CO,NO2,O3,PM10 during pregnancy seemed to be associated with congenital heart diseases.
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Objective To explore the association between exposure to ambient air pollution during pregnancy and congenital heart disease so as to provide evidence for primary prevention of congenital heart disease.Methods Epidemiologic studies on ambient air pollution and congenital heart diseases were reviewed.Summary risk estimates were calculated at high versus low exposure levels and risk per-unit-increase in continuous pollutant concentration.Meta-analysis was conducted with Stata 12.0 software.Results A total of 20 articles in English were qualified for inclusion.Results from Meta-analysis showed that CO exposures were related to the increase on the risk of tetralogy of fallot (high versus low exposure level OR=1.22,95％CI:1.03-1.44),while the exposures to NO2 were related to the increase on risk of coarctation of aorta (per 10 mm3/m3 OR=1.01,95％CI:1.01-1.20).Exposures to O3 were related to the increase on risk of atrial septal defect (per 10 mm3/m3 OR=1.14,95％CI:1.03-1.26),and PM10 exposures were related to the increase on risk of atrial septal defect (per 10 μg/m3 OR=1.10,95％CI:1.03-1.19).In addition,there were inverse associations between CO and atrial septal defect and between PM10 and ventricular septal defect.Conclusion Exposures to CO,NO2,O3,PM10 during pregnancy seemed to be associated with congenital heart diseases.
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<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of gastric hepatoid adenocarcinoma(HAS).</p><p><b>METHODS</b>Retrospective analysis of clinicopathological data of 24 cases with gastric HAS diagnosed by surgery and pathology in Chinese PLA General Hospital from January 2013 to May 2016 were carried out. All the patients underwent preoperative serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), endoscopy and imaging examination (CT or B-mode ultrasonography), and those with elevated AFP were excluded from liver cancer, cirrhosis, endodermal sinus tumor and other diseases. The follow-up ended in June 2016 or the death of the patient. The survival was from the operation to the death of the patient or the end of follow-up.</p><p><b>RESULTS</b>There were a total of 24 cases with gastic HAS, accounting for 1.03%(24/2 326) of the total number of patients with gastric cancer diagnosed at the same time in our center. There were 19 males and 5 females, the ratio of male to female was 3.8:1.0, the mean age of the patients was 55.9 (31 to 72) years, and 2 of them had liver metastasis. The first symptom in 50% (12/24) patients was epigastric pain, in 25%(6/24) was abdominal distension with vomiting, and the rest included dysphagia (12.5%, 3/24), hematemesis (8.3%, 2/24) and melena (4.2%, 1/24). Preoperative serum levels of AFP and CEA were elevated in 10 (41.7%) and 5 patients (20.8%) respectively. All the patients underwent surgical treatment, including 23 cases with D2 radical resection of gastric cancer and R0 resection, and the other of palliative gastrojejunostomy. Lesions of HAS located in gastric antrum in 11 cases (45.8%), in cardia in 7 cases (29.2%), and in gastric body in 6 cases (25%). Tumor maximum diameter of 10 cases was larger than 5 cm, and the average diameter was 5.7(1.0 to 12.0) cm. Postoperative pathological TNM staging: stage I(b was in 1 cases, stage II( in 7 cases, stage III( in 14 cases, stage IIII( in 2 cases; lymph node metastasis in stage N1-3 in 20 cases (83.3%). Poorly-differentiated tumors were found in 21 cases (87.5%), and no well-differentiated tumors were found. There were 11 cases (45.8%) with formation of intravascular tumor thrombi. In immunohistochemistry, AFP positive expression was found in 11 cases(45.8%). Seventeen HAS cases (70.8%, 17/24) received postoperative SOX(oxaliplatin + S-1) or XELOX (oxaliplatin + capecitabine) as adjuvant chemotherapy, 5 cases postoperative immune therapy, and 2 cases postoperative traditional Chinese medicine. All the patients were followed up for 0.7 to 42.0 months (median 8 months). A total of 9 patients died, of whom, 1 case underwent gastrojejunostomy because of liver and peritoneal metastasis before operation, and died 20 days after surgery; 4 cases died of multiple liver metastases after 1.5 to 12.0 months with survival of 3 to 18 months; 3 cases presented local recurrence after 2 to 17 months with survival of 6 to 22 months; 1 cases had peritoneal metastasis after 12 month with survival of 26 months.</p><p><b>CONCLUSIONS</b>HAS is a rare type of gastric cancer with poor prognosis. The diagnosis is mainly based on histopathology, and radical resection is the mainstay treatment.</p>
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AIM:To establish a mouse model of immuno-inflammation in central nervous system (CNS) associated with cognitive dysfunction.METHODS:C57BL/6J male mice were divided into 3 groups.Lipopolysaccharide (LPS) was intraperitoneally injected into the mice to induce cognitive impairment.Morris water maze test, passive avoidance test and pole test were used to observe the behavioral changes of mice.The histomorphology was analyzed by the method of immunofluorescence.The detailed molecular mechanism was determined by Western blot.RESULTS:Compared with saline group, LPS induced mouse sickness behavior and memory loss.Microglia activation and neuronal loss in the hippocampus were observed.The expression of neuroinflammatory proteins COX-2 and iNOS in the brain of LPS-induced mice was increased.CONCLUSION:Intraperitoneal injection of LPS induces cognitive dysfunction in mice.
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<p><b>OBJECTIVE</b>To compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology. Patients with incomplete data were excluded. The complications among open group, laparoscopic group and robotic group were compared. The continuous variables were analyzed by one-way ANOVA, and categorical variables were analyzed by χtest or Fisher exact test.</p><p><b>RESULTS</b>A total of 1 791 patients (1 320 males and 471 females) were included in the study, aged from 17 to 98 (59.0±11.6) years, comprising 922 open, 673 laparoscopic and 196 robotic gastrectomies. There were no significant differences among three groups in baseline data (gender, age, BMI, comorbidity, radiochemotherapy) and some of operative or postoperative data (blood transfusion, number of lymph node dissection, combined organ resection, resection site, N stage, postoperative hospital stay). The blood loss in laparoscopic and robotic groups was significantly lower than that in open group[(185.7±139.6) ml and (194.0±187.6) ml vs. (348.2±408.5) ml, F=59.924, P=0.000]. The postoperative complication occurred in 197 of 1 791(11.0%) patients. The Clavien-Dindo II(, III(a, III(b, IIII(a, and IIIII( complications were 5.5%, 4.0%, 1.2%, 0.1%, and 0.2% respectively. The anastomotic leakage (2.4%), intestinal obstruction(1.3%) and pulmonary infection(1.2%) were the three most common complications, followed by wound infection(0.8%), cardiovascular disease(0.7%), anastomotic bleeding (0.7%), delayed gastric emptying (0.6%), duodenal stump fistula(0.5%), intraperitoneal hemorrhage (0.5%), pancreatic fistula (0.3%), intra-abdominal infection(0.2%), chylous leakage (0.1%) and other complications(1.7%). There were no significant differences among three groups as the complication rates of open, laparoscopic and robotic gastrectomy were 10.6%(98/922), 10.8%(73/673) and 13.3%(26/196) respectively (χ=1.173, P=0.566). But anastomotic leakage occurred more common after laparoscopic and robotic gastrectomy compared to open gastrectomy [3.1%(21/673) and 5.1%(10/196) vs. 1.3%(12/922), χ=12.345, P=0.002]. The rate of cardiocerebral vascular diseases was higher in open group[1.3%(12/922) vs. 0.1%(1/673) and 0, χ=8.786, P=0.012]. And the rate of anastomotic bleeding was higher in robotic group [2.0%(4/196) vs. open 0.4%(4/922) and laparoscopic 0.6%(4/673), χ=6.365, P=0.041]. In view of Clavien-Dindo classification, III(a complications occurred more common in laparoscopic group [5.5%(37/673) vs. open 3.3%(30/922) and robotic 2.6%(5/196), χ=6.308, P=0.043] and III(b complications occurred more common in robotic group [3.1%(6/196) vs. open 1.1%(10/922) and laparoscopic 0.7%(5/673), χ=7.167, P=0.028].</p><p><b>CONCLUSIONS</b>Morbidities of postoperative complications are comparable among open, laparoscopic and robotic gastrectomy for gastric cancer. However, in consideration of the high difficulty of anastomosis, the minimally invasive surgery should be performed by more experienced surgeons.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anastomotic Leak , Epidemiology , Blood Loss, Surgical , Cerebrovascular Disorders , Epidemiology , Chylous Ascites , Epidemiology , Comorbidity , Comparative Effectiveness Research , Duodenal Diseases , Epidemiology , Gastrectomy , Methods , Gastrointestinal Hemorrhage , Epidemiology , Gastroparesis , Epidemiology , Gastroscopy , Hemoperitoneum , Epidemiology , Intestinal Fistula , Epidemiology , Intraabdominal Infections , Epidemiology , Laparoscopy , Length of Stay , Lymph Node Excision , Postoperative Complications , Epidemiology , Postoperative Hemorrhage , Epidemiology , Postoperative Period , Respiratory Tract Infections , Epidemiology , Retrospective Studies , Risk Assessment , Robotic Surgical Procedures , Stomach Neoplasms , General Surgery , Surgical Wound Infection , EpidemiologyABSTRACT
Objective To evaluate the effect of the combined supplementation of folic acid,vitamin B12 and B6 on the risk of cardio-cerebrovascular diseases.Methods The literatures of randomized control trials about the relationship between the combined supplementation of folic acid,vitamin B 12 and B6 and risk of cardio-cerebrovascular diseases from 1980 to 2014 were retrieved,and the eligible studies were screened for a Meta-analysis.The study indicators were the incidences of cardiovascular disease events,myocardial infarction and stroke.The cffect indicators were relative risk (RR) and 95％ confidence interval (CI).Jadad score was used for the quality evaluation of the trials used in the study.Results The literatures of 11 randomized control trials,involving 26 395 patients,were used in the Meta-analysis.The combined supplementation of B vitamins had no effect on the incidence of cardiovascular disease events (RR=1.00,95％ CI:0.94-1.07) based on 8 studies.The combined supplementation of B vitamins had no effect on the incidence of myocardial infarction (RR =1.03,95％ CI:0.94-1.13) based on 9 studies.The combined supplementation of B vitamins could reduce the incidence of stroke by 14％ (RR=0.86,95％CI:0.78-0.95) based on 9 studies.Compared with the control group,Taking folic acid combined with vitamin B12 and B6 could reduce the level of homocysteine by 2.53 μmol/L (95％CI:-3.93--1.12).Subgroup analysis indicated that the follow-up time,the dosage of folic acid and vitamin B12 and B6,the history of diseases had no confounding effect on the incidence of cardio-cerebrovascular disease events.But the subgroup analysis for stroke showed that with the extension of follow-up time,the supplementation of B vitamins could reduce the risk of stroke.The effect of folic acid and B12 in small dosage seemed more significant in the prevention of stroke,while the preventive effect of B6 increased with increasing dosage.The preventive effect of combined supplementation of B vitamins was more significant for the patients with a history of cardio-cerebrovascular diseases.Conclusion Taking folic acid combined with vitamin B6 and B12 might have no significant effect on the incidences of cardio-cerebrovascular disease events and myocardial infarction,but could lower the risk of stroke and the level of homocysteine.
ABSTRACT
Objective To evaluate the effect of the combined supplementation of folic acid,vitamin B12 and B6 on the risk of cardio-cerebrovascular diseases.Methods The literatures of randomized control trials about the relationship between the combined supplementation of folic acid,vitamin B 12 and B6 and risk of cardio-cerebrovascular diseases from 1980 to 2014 were retrieved,and the eligible studies were screened for a Meta-analysis.The study indicators were the incidences of cardiovascular disease events,myocardial infarction and stroke.The cffect indicators were relative risk (RR) and 95％ confidence interval (CI).Jadad score was used for the quality evaluation of the trials used in the study.Results The literatures of 11 randomized control trials,involving 26 395 patients,were used in the Meta-analysis.The combined supplementation of B vitamins had no effect on the incidence of cardiovascular disease events (RR=1.00,95％ CI:0.94-1.07) based on 8 studies.The combined supplementation of B vitamins had no effect on the incidence of myocardial infarction (RR =1.03,95％ CI:0.94-1.13) based on 9 studies.The combined supplementation of B vitamins could reduce the incidence of stroke by 14％ (RR=0.86,95％CI:0.78-0.95) based on 9 studies.Compared with the control group,Taking folic acid combined with vitamin B12 and B6 could reduce the level of homocysteine by 2.53 μmol/L (95％CI:-3.93--1.12).Subgroup analysis indicated that the follow-up time,the dosage of folic acid and vitamin B12 and B6,the history of diseases had no confounding effect on the incidence of cardio-cerebrovascular disease events.But the subgroup analysis for stroke showed that with the extension of follow-up time,the supplementation of B vitamins could reduce the risk of stroke.The effect of folic acid and B12 in small dosage seemed more significant in the prevention of stroke,while the preventive effect of B6 increased with increasing dosage.The preventive effect of combined supplementation of B vitamins was more significant for the patients with a history of cardio-cerebrovascular diseases.Conclusion Taking folic acid combined with vitamin B6 and B12 might have no significant effect on the incidences of cardio-cerebrovascular disease events and myocardial infarction,but could lower the risk of stroke and the level of homocysteine.
ABSTRACT
<p><b>BACKGROUND</b>Talaromyces (Penicillium) marneffei (TM) is an emerging dimorphic human pathogenic fungus that is endemic to Southeast Asia. TM mostly occurs as an opportunistic infection in patients with human immunodeficiency virus (HIV). The objective of this study was to compare the clinical and laboratory parameters of patients with TM infections who were HIV-positive and HIV-negative and to assess therapies and outcomes.</p><p><b>METHODS</b>This was a retrospective analysis of 26 patients diagnosed with disseminated TM infection from September 2005 to April 2014 at Fujian Provincial Hospital, China.</p><p><b>RESULTS</b>Patients with TM infection tend to present with fever, weight loss, and anemia. The time from symptom onset to confirmed diagnosis was greater for HIV-negative patients (n = 7; median: 60 days, range: 14-365 days) than for HIV-positive patients (n = 19; median: 30 days, range: 3-90 days, Mann-Whitney U = 31.50, P= 0.041). HIV-negative patients were more likely to have dyspnea (57.1% vs. 5.3%, χ2 = 8.86, P= 0.010), low neutrophil count (Mann-Whitney U = 27.00, P= 0.029), high CD4 count (Mann-Whitney U = 0.00, P= 0.009), and high lymphocyte count (Mann-Whitney U = 21.00, P= 0.009). There were no significant differences in other demographic, clinical, or biochemical characteristics. Among all the patients, 12 HIV-positive patient and 1 HIV-negative patient received amphotericin and fluconazole treatment, 9 of whom improved, 1 died, 2 had kidney damage, 1 had hypokalemia due to exceeded doses.</p><p><b>CONCLUSIONS</b>HIV-negative patients with TM infections tend to have a longer diagnostic interval, a higher percentage of dyspnea, higher levels of CD4 and lymphocytes, and lower neutrophil counts than TM infection in HIV-positive patients. Treatment programs with amphotericin and fluconazole are mostly effective.</p>