Burden of disease and risk factors among children under 5 years in China from 1990 to 2019: a perspective of international comparison / 中华预防医学杂志

Based on the Global Burden of Disease study 2019, the standardized mortality rate and disability-adjusted life years (DALYs) rate of children under 5 years old were selected as evaluation indicators to compare and analyze the current situation and differences of disease burden of children under 5 years old between China and other regions from 1990 to 2019. The change trend and difference of disease burden of children under 5 years old in China were analyzed by sexes. From 1990 to 2019, the all-cause standardized mortality rate of children under 5 years old in China decreased from 1 153.81/100 000 to 160.39/100 000, and the all-cause standardized DALY rate decreased from 104 426.40/100 000 to 16 479.01/100 000. In 2019, neonatal preterm birth, congenital heart anomalies and lower respiratory infections ranked the top three disease burden of children under 5 years old in China. Except that the disease burden of neonatal preterm birth was lower than that in North America, they were much higher than that in Western Europe and North America in the same period. The burden of unintentional injury diseases, including pulmonary aspiration and foreign body in airway and drowning, was higher than that in Western Europe and North America. The standardized mortality and DALY rate of the top ten diseases and injuries in boys and girls under 5 years old in China showed a downward trend (P<0.05), and most of them were higher in boys than girls (P<0.05). From 1990 to 2019, the disease burden of children under 5 years old in China decreased significantly. However, compared other regions, it is still necessary to strengthen the prevention and control of neonatal premature birth, birth defects and unintentional injuries, and take different sex-specific interventions to improve the overall health of children.

Early therapeutic interventions of traditional Chinese medicine in COVID-19 patients: A retrospective cohort study / 中西医结合学报

OBJECTIVE@#To observe the early interventions of traditional Chinese Medicine (TCM) on the conversion time of nucleic acid in patients with coronavirus disease 2019 (COVID-19), and find possible underlying mechanisms of action.@*METHODS@#A retrospective cohort study was conducted on 300 confirmed COVID-19 patients who were treated with TCM, at a designated hospital in China. The patients were categorized into three groups: TCM1, TCM2 and TCM3, who respectively received TCM interventions within 7, 8-14, and greater than 15 days of hospitalization. Different indicators such as the conversion time of pharyngeal swab nucleic acid, the conversion time of fecal nucleic acid, length of hospital stay, and inflammatory markers (leukocyte count, and lymphocyte count and percentage) were analyzed to observe the impact of early TCM interventions on these groups.@*RESULTS@#The median conversion times of pharyngeal swab nucleic acid in the three groups were 5.5, 7 and 16 d (P < 0.001), with TCM1 and TCM2 being statistically different from TCM3 (P < 0.01). TCM1 (P < 0.05) and TCM3 (P < 0.01) were statistically different from TCM2. The median conversion times of fecal nucleic acid in the three groups were 7, 9 and 17 d (P < 0.001). Conversion times of fecal nucleic acid in TCM1 were statistically different from TCM3 and TCM2 (P < 0.01). The median lengths of hospital stay in the three groups were 13, 16 and 21 d (P < 0.001). TCM1 and TCM2 were statistically different from TCM3 (P < 0.01); TCM1 and TCM3 were statistically different from TCM2 (P < 0.01). Both leucocyte and lymphocyte counts increased gradually with an increase in the length of hospital stay in TCM1 group patients, with a statistically significant difference observed at each time point in the group (P < 0.001). Statistically significant differences in lymphocyte count and percentage in TCM2 (P < 0.001), and in leucocyte count (P = 0.043) and lymphocyte count (P = 0.038) in TCM3 were observed. The comparison among the three groups showed a statistically significant difference in lymphocyte percentage on the third day of admission (P = 0.044).@*CONCLUSION@#In this study, it was observed that in COVID-19 patients treated with a combination of Chinese and Western medicines, TCM intervention earlier in the hospital stay correlated with faster conversion time of pharyngeal swab and fecal nucleic acid, as well as shorter length of hospital stay, thus helping promote faster recovery of the patient. The underlying mechanism of action may be related to improving inflammation in patients with COVID-19.

Effects of Tanreqing Capsule on the negative conversion time of nucleic acid in patients with COVID-19: A retrospective cohort study / 中西医结合学报

OBJECTIVE@#Traditional Chinese medicine plays a significant role in the treatment of the pandemic of coronavirus disease 2019 (COVID-19). Tanreqing Capsule (TRQC) was used in the treatment of COVID-19 patients in the Shanghai Public Health Clinical Center. This study aimed to investigate the clinical efficacy of TRQC in the treatment of COVID-19.@*METHODS@#A retrospective cohort study was conducted on 82 patients who had laboratory-confirmed mild and moderate COVID-19; patients were treated with TRQC in one designated hospital. The treatment and control groups consisted of 25 and 57 cases, respectively. The treatment group was given TRQC orally three times a day, three pills each time, in addition to conventional Western medicine treatments which were also administered to the control group. The clinical efficacy indicators, such as the negative conversion time of pharyngeal swab nucleic acid, the negative conversion time of fecal nucleic acid, the duration of negative conversion of pharyngeal-fecal nucleic acid, and the improvement in the level of immune indicators such as T-cell subsets (CD3, CD4 and CD45) were monitored.@*RESULTS@#COVID-19 patients in the treatment group, compared to the control group, had a shorter negative conversion time of fecal nucleic acid (4 vs. 9 days, P = 0.047) and a shorter interval of negative conversion of pharyngeal-fecal nucleic acid (0 vs. 2 days, P = 0.042). The level of CD3@*CONCLUSION@#Significant reductions in the negative conversion time of fecal nucleic acid and the duration of negative conversion of pharyngeal-fecal nucleic acid were identified in the treatment group as compared to the control group, illustrating the potential therapeutic benefits of using TRQC as a complement to conventional medicine in patients with mild and moderate COVID-19. The underlying mechanism may be related to the improved levels of the immune indicator CD3

Double-door laminoplasty combined with C dome decompression for the treatment of cervical spinal stenosis / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double-door laminoplasty combined with C dome decompression in treatment of cervical spinal stenosis.@*METHODS@#The clinical data of 28 patients with cervical spinal stenosis who underwent double-door laminoplasty combined with C dome decompression from June 2016 to June 2018 were retrospectively analyzed, including 17 males and 11 females, aged 39 to 74 years with an average of (61.0±6.7) years. The clinical effects were evaluated by JOA score, axial symptoms, cervical spine activity, cervical spinal cord compression degree and so on.@*RESULTS@#All patients were followed up for 6 to12 months with an average of 10.2 months. The JOA score in the final follow-up was significantly improved (0.05). After operation, sagittal diameter at the narrowest level of C-C spinal canal was (16.20±1.82) mm, which was significantly higher than (8.38±1.16) mm before operation (<0.05). There were 4 cases with axial symptoms in 24 patients with the incidence rate of 14.29% (4/24).@*CONCLUSION@#Double-door laminoplasty combined with C dome decompression can directly expand the volume of C-C spinal canal, relieve the compression of spinal cord and nerve root, reduce the damage to the posterior cervical ligament complex as much as possible, maintain the stability of cervical spine sequence, reduce the occurrence of axial symptoms, and the operation is relatively simple, without the need of metal internal fixation.

Application of "Zoning Method" foraminotomy in posterior cervical endoscopic surgery / 中国骨伤

OBJECTIVE@#To explore the safety, effectiveness and consistency of "Zoning Method" foraminotomy in posterior cervical endoscopic surgery.@*METHODS@#From March 2016 to October 2018, 21 patients with cervical spondylotic radiculopathy were enrolled. Endoscopic foraminotomy and nucleus pulposus enucleation were performed in the patients. There were 13 males and 8 females, aged from 35 to 56 years old with an average of (47.3±5.1) years. The surgical segment of 6 cases were C, 10 cases were C and 5 cases were C. The "Zoning Method" was proposed and used to complete the foraminotomy under endoscope, and then to perform nucleus pulposus removal and nerve root decompression. The operation length, intraoperative bleeding volume and complications were recorded, and NDI, VAS were evaluated before operation, 1 day after the operation and 1 week after the operation.@*RESULTS@#All the operations were successful. The operation length was(46.10±26.39) min, intraoperative bleeding volume was (50.10±18.25) ml, and there were no complications such as nerve injury, dural tear or vertebral artery injury. All 21 patients were followed up for 3 to 9 months, with a median of 6 months. Postoperative VAS and NDI were obvious improved (0.05).@*CONCLUSION@#Endoscopic foraminotomy with "Zoning Method" is safe clinically significant, and consistent.

Prognostic factors of survival in patients with metastatic renal cell carcinoma after bone metastasectomy / 中华泌尿外科杂志

Objective:To investigate the factors related to the prognosis of patients with metastatic renal cell carcinoma after bone metastasectomy and to provide a reference for the clinical treatment of renal cell carcinoma.Methods:The clinical data of 143 patients with metastatic renal cell carcinoma in our center from January 2008 to December 2018 were retrospectively collected. Among 143 patients, 121 were male and 22 were female, with the average age of (54.8±12.5) year-old(from 18 to 85 year-old). The KPS scores of 138 patients were no higher than 80%. According to International Metastatic RCC Database Consortium (IMDC) risk model for metastatic renal cell carcinoma, the patients were divided into intermediate risk group (92 patients) and poor risk group (51 patients). The patients who had received complete resection for both primary lesion and metastatic tumor were regarded as tumor-free (47 patients). Otherwise, the patients with unresectable primary tumor or incomplete resection of the metastatic tumor were defined as the patients surviving conversely bone metastases were the only metastatic site, and the other 57 patients also experienced concomitant metastases comparatively. Sixty-two patients only had solitary bone metastasis lesion and 81 patients had multiple bone metastases. Kaplan-Meier survival analysis was used to calculate the 1-year, 3-year and 5-year survival rate. The impacts of different variables on the prognosis were examined by log-rank test. Univariate analysis and multivariable Cox proportional hazards regression models were used to identify the independent risk factors.Results:The median follow-up time was 49.0 months. The overall survival was 1-115 months, with the median OS was 24.0 months. The 1-year, 3-year and 5-year survival rate were 79.2%, 59.4% and 31.6%, respectively. All the patients underwent bone metastasectomy and 72 of them were treated with targeted therapy. The pathology results of metastasectomy were clear cell carcinoma for 132 patients and non-clear cell carcinoma for the 11 patients. In tumor-free group, the median OS was 30.0 months and in survival with tumor group, the median OS was 19.4 months, with a significant difference between the two groups ( P=0.030). In IMDC intermediate risk group, the prognosis was improved among the patients who received post-surgical targeted therapy after metastasectomy (24.3 months vs. 16.8 months, P=0.027), whereas the difference was not significant for IMDC poor risk group ( P=0.449). Age ≥60 years and multiple bone metastases sites were proved to be the independent risk factors for the prognosis of patients with metastatic renal cell carcinoma after bone metastasectomy. Conclusions:The prognosis of RCC patients with bone metastases was generally poor. Metastasectomy could prolong the OS of the patients who had undergone primary nephrectomy and had solitary bone metastasis. Metastasectomy combined with targeted therapy could significantly improve the prognosis of the IMDC intermediate risk patients. However, the effect of targeted therapy among IMDC poor risk patients remained to be further proved.

Concordant point mutation of ETS-related gene (ERG) in tumor tissues from a synchronous multiple primary lung cancer: A case report / 北京大学学报(医学版)

The rearrangement of the gene encoding the transcription factor ETS-related gene (ERG) is thought to play a key role in the development of prostate cancer. However, the studies on the ERG mutations have been rarely reported in non-small cell lung carcinoma (NSCLC). Here, we reported genetic features regarding a case of a 68-year-old male patient who presented the primary synchronous multiple tumor lesions in the separated lungs. The patient was hospitalized due to the presence of tumor lesions at the right and left lungs revealed by a chest computerized tomography (CT) scan. After conducting lobectomies at the both lungs, the tumor nodules were all removed, and the histological analysis suggested adenocarcinoma at the both tumor lesions. The patient was diagnosed with synchronous multiple primary lung cancer (SMPLC) based on Martini-Melamed criteria and American College of Chest Physicians practice guidelines. An exome analysis of 315 genes in the two tumor lesions and a non-tumor lesion was conducted by using Illumina Nextseq500 platform from each tumor region to decipher a potential evolutional progress of SMPLC. Single or pair-end reads were first mapped to a human genome reference and filtered based on the mapping quality score. The read depth was ≥ 1 000× and the depth of coverage was 95%. The data revealed a discordant epidermal growth factor receptor (EGFR) from the separate lungs; additionally, a high frequency of point mutation on exon 9 H310P of the ERG gene was detected at the both sites of the tumor lesions. This case showed that a potential role of the molecular features analysis from each tumor lesion might contribute to the understanding of the evolutional development of SMPLC. This study suggests that the same environment may contribute certain gene(s) mutations in the same sites in the early stages of polyclonal tumor origins; meanwhile the extensive studies on these genes may help us understand the evolution and progress of tumor clones.

Application of near infrared spectroscopy analysis method in rapid detection of sodium aescinate / 药学实践杂志

Objective To establish a fast detection method of sodium aescinate by using near infrared (NIR) spectroscopy analysis method for the determination of the content of sodium aescinate for injection. Methods OPUS software was used to optimize the collected spectrum. PLS algorithm and factorization algorithm were used to establish quantitative model and qualitative model. Results The correlation coefficient of the quantitative model reached 0.9926, the RMSECV deviation was 0.253. The deviation between the predicted value of the sample and the true measured value was less than 5%, which could accurately predict the content of sodium aescinate. Conclution The qualitative model can effectively distinguish the samples of other varieties that have not participated in the modeling, and provide a reference for the rapid screening of the drug.

Research progress in lipid-drug conjugates / 药学学报

The technology of lipid-drug conjugates is developed on the basis of prodrug principle, which overcomes some drawbacks of drugs via increasing the lipophilicity of hydrophilic or poorly soluble drugs to promote the absorption of drugs and enhance the curative effect. This article sums up the research progress of lipid-drug conjugates from the chemical synthesis methods of conjugates, the types of conjugates, the influence on biological activity of drugs, the application in nanoparticles for drug delivery and the mechanism of absorption and degradation.

Analysis of perioperative parameters and renal function in elderly patients with clinical T1-T2 renal masses treated by partial nephrectomy and radical nephrectomy / 中华泌尿外科杂志

Objective To compare the perioperative parameters and renal function in patients,whose aged was 65 year-old or above,with clinical T1-2 renal tumors undergoing partial nephrectomy (PN) or radical nephrectomy (RN).Methods A retrospective review of 469 patients,who underwent RN and PN in our center,was conducted from January 2012 to November 2018,icluding 247 in the RN group and 222 in the PN group.The RN group consisted of 170 male and 77 female patients,with the mean age of (70.96 ± 5.21) year-old.126 cases were found that the tumor located on the fight side,with the median diameter of (4.93 ± 2.03) cm.The median BMI,median R.E.N.A.L.score and pre-operation eGFR of the RN group were (24.4 ± 3.1) kg/m2,8.39 ± 1.45) and (80.23 ± 15.14) ml/(min · 1.73 m2),respectively.The PN group consisted of 150 male and 72 female patients,with the mean age of (70.23 ± 4.62) years old.108 patients had tumors on the left side while 114 on the right side,with the median diameter of (3.17 ± 1.41) cm.The median BMI,median R.E.N.A.L score and pre-operation eGFR of the PN group were (23.5 ± 3.2) kg/m2,(6.69 ± 1.81) and (82.83 ± 14.36) ml/(min · 1.73m2),respectively.No statistical difference was noticed in the age,gender,tumor location and BMI between RN group and PN group(P ＞ 0.05).The PN group had smaller tumors and lower R.E.N.A.L.scores than the RN group (P ＜ 0.05).Various parameters were compared between the PN and RN groups,including operative duration,surgical procedure,intraoperative blood loss,perioperative blood transfusion,drainage tube removal time,postoperative duration of hospitalization,pathological results,the renal function immediately after surgery and at 1 month,1 year,2 years,3 years,4 years,5 years after surgery,and the incidence of chronic renal dysfunction.Results Significant differences were found in multiple variables between the two cohorts,such as operative duration [(115.70 ± 39.69) min in RN vs.(132.26 ± 49.02) min in PN],estimated intraoperative blood loss [(45.85 ± 55.93) days in RN vs.(66.60 ± 61.55) ml in PN],drainage tube removal time [(4.38 ± 1.71) days in RN vs.(4.86 ± 1.61) days in PN],duration of postoperative hospitalization [(5.14 ± 1.65) days in RN vs.(5.52 ± 1.32) days in PN] (P ＜ 0.05).Furthermore,higher proportion of RCC was detected in the RN cohort (93.5％ in RN vs.86.5 ％ in PN,P ＜ 0.05).There was no significant difference in perioperative blood transfusion rate between the two cohorts (10.93％ vs.9.01％,P ＞ 0.05).Compared with the RN cohort,the PN cohort had higher eGFR immediately after surgery [(74.08 ± 18.31) ml/(min · 1.73m2) vs.(52.58 ± 14.21) ml/(min · 1.73m2)],1 month after surgery [(76.11 ± 18.34) ml/(min · 1.73m2) vs.(53.78 ± 15.03)ml/(min · 1.73m2)] and at the last follow-up [(73.92 ± 18.59) ml/(min · 1.73m2) vs.(52.35 ± 16.13) ml/(min · 1.73m2)] (P ＜ 0.001).Compared with those of the RN cohort,the incidences of eGFR ＜ 45 ml/(min · 1.73m2) of the PN cohort were lower immediately after surgery [9.01％ (20/222) vs.31.9％ (79/247)],1 month after surgery [7.87％ (14/178) vs.27.31％ (62/227)],1 year after surgery [8.96％ (13/145) vs.38.75％ (62/16 0)],2 years after surgery [9.89％ (9/91) vs.31.57％ (42/133)],3 years after surgery [13.21％ (7/53) vs.30.61％ (30/98)],4 years after surgery [16.21％ (6/37) vs.30.26％ (23/76)] and 5 years after surgery [18.18％ (4/22) vs.31.11％ (14/45)] (P ＜ 0.001).Conclusion The perioperative risk of PN in the treatment of elderly patients aged 65 and above with clinical cT1-2 renal tumor is controllable.PN could better retain renal function for those patients and reduce the risk of postoperative chronic renal insufficiency.

Quantitative evaluation of image quality of megavoltage computed tomography for guiding helical tomotherapy / 北京大学学报(医学版)

OBJECTIVE@#To quantitatively analyze image quality of two sets of phantom (CatPhan504 and Cheese) Megavoltage computed tomography (MVCT) images acquired by Helical Tomotherapy with three scanning modes (Fine, Normal and Coarse), and to explore and validate a semi-automatic quality assurance procedure for MVCT images of Helical Tomotherapy.@*METHODS@#On Helical Tomotherapy, CatPan504 and Cheese phantoms were scanned with three pitch levels (Fine, Normal, Coarse: 4 mm, 8 mm, 12 mm/circle) respectively. Pylinac, Matlab and Eclipse were used to calculate and compare spatial resolution, noise level and low contrast resolution of images obtained under three scanning modes respectively. The spatial resolution can be evaluated by the blurring of line-pair CT value in the images of CatPhan504's CTP528 module. The noise level can be evaluated by the integral non-uniformity in the images of Cheese's uniformity module. the low contrast resolution can be evaluated by contrast-to-noise ratio of both phantoms' plug-in module, or visibility of the region of interest (Supra-Slice) in the images of CatPhan504's CTP515 module.@*RESULTS@#Analyses on CatPhan504's line pair module(CTP528 module) showed that the first three line pairs(the gap size are 0.500 cm, 0.250 cm and 0.167 cm respectively) could be clearly observed but blurring began to occur from the fourth line pair(the gap size is 0.125 cm) under Coarse mode. Meanwhile, the first four line pairs were all observable under the Normal and Fine modes. Integral non-integrity index(the value negatively correlated with the noise level) were 0.155 7, 0.136 8 and 0.122 9 for Coarse, Normal and Fine modes respectively. None of the Supra-Slice in CatPhan504's CTP515 module could be observed under three imaging modes. Low contrast contrast-to-noise ratio of Cheese phantom was similar under three modes and the insert visibility exhibited nearly linear growth with the increasing difference between CT average value of the insert material and background.@*CONCLUSION@#Superiority and inferiority of three image modes in terms of the three image quality index was not consistent. Evaluation results above could provide reference for more rational decision on scanning modes selection of helical tomotherapy, which was based on image visualization demands in clinical practice. The proposed method could also provide guidance for similar image quality assessment and periodic quality assurance.

Clinical observation of femtosecond laser capsulorhexis with toric intraocular lens implantation / 眼科新进展

Objective To evaluate the clinical effect of femtosecond laser assisted cataract surgery with Toric IOL implantation on correcting astigmatism and IOL rotating stability.Methods A prospective,nonrandomized,controlled study was conducted in 68 patients (82 eyes) diagnosed as age-related cataract with more than 1.0 diopter (D) regular astigmatism,including 41 eyes undergoing Toric IOL implantation with femtosecond laser assisted cataract surgery,and the other eyes receiving Toric IOL with phacoemulsification.And observation was performed for the uncorrected visual acuity (UCVA) before operation and 6 months after operation,preoperative corneal astigmatism,anticipated and postoperative residual astigmatism 6 months after operation.Then,comparison was performed for the degree of Toric lens axis rotation,as well as the horizontal and vertical movement of the IOL and the degree of vertical deflection in the capsule at 1,3,and 6 months after operation.Results In the observation group,preoperative UCVA (logMAR),preoperative corneal astigmatism,postoperative BCVA and the residual astigmatism at 6 months after operation was 1.03 ± 0.32,(2.09 ± 0.73) D,0.13 ± 0.11 and (0.33 ± 0.27) D,respectively,while the corresponding data in the control group was 0.92 ± 0.40,(1.69 ± 0.64) D,0.13 ± 0.09,(0.26 ± 0.22) D;the postoperative visual acuity in both groups was significantly improved,and residual astigmatism was significantly decreased at 6 months after operation (all P ＜ 0.001).There was no significant difference in Toric lens axis after femtosecond laser assisted surgery and phacoemulsification at 1 month,3 months,6 months after operation (all P ＞ 0.05),but the differences in the IOL movement in horizontal and vertical direction were statistically significant at the different time-points (all P ＜ 0.05),and there was significant differences in the degree of vertical deflection (all P ＜ 0.05).Conclusion Both femtosecond laser assisted cataract surgery and phacoemulsification combined with Toric IOL can achieve a better stability and predictability.

Comparison of acarbose and metformin as add-on therapy to insulin in uncontrolled patients with type 2 diabetes mellitus: A randomized, open-labeled, and parallel group study / 中华内分泌代谢杂志

Objective To evaluate efficacy and safety of acarbose compared with metformin as add-on therapy in patients with type 2 diabetes mellitus inadequately controlled with insulin. Methods This was a randomized, open-labeled, and parallel group study. Ninety-one type 2 diabetic patients ( HbA1C7.5%-11.0%) who were suboptimally controlled despite receiving twice daily injection of insulin (30-60 U/d for at least 8 weeks) were enrolled. They were randomly assigned 1 ∶ 1 ∶ 1 to continuation of insulin, insulin with acarbose (Ins+Aca), and insulin with metformin (Ins+Met) groups to insulin treatment. The levels of HbA1C, oral glucose tolerance test, blood lipids etc were measured at baseline and 12 weeks, and adverse events were recorded. Results The mean HbA1C levelsdecreasedfrom(7.9±0.4)%atbaselineto(7.0±0.3)%atweek12(P＜0.01)intheIns+Acagroupand(7.8 ±0.2)%to(7.0±0.3)%in the Ins+Met group(P＜0.01), while no significant change in HbA1Cin the insulin alone group. Adding acarbose to insulin resulted in similar reductions in HbA1Crelative to metformin (P＝0.431). The achievement rate of HbA1Cbelow 7.0%at week 12 was the same(both 70%) between the Ins+Aca group and the Ins+Met group. Insulin combined with acarbose in improving blood glucose fluctuation effect was more significant than that incombinationwithmetformin(P＜0.01),withstandarddeviation(SD)ofbloodglucose[(1.1±0.5vs2.7±0.6) mmol/L, P＜0.01], postprandial blood glucose fluctuations [(0.5 ± 0.7 vs 2.8 ± 0.4) mmol/L, P＜0.01], the maximumbloodglucosefluctuations[(2.8±0.7vs4.6±0.6)mmol/L,P＜0.01].Theweightlossoccurredinboththe Ins+AcaandtheIns+Metgroups[-(0.5±0.8vs1.0±0.4)kg].Therewasnosignificantchangesinbloodpressure and lipid profile. Hypoglycemic episodes were comparable in all groups. No serious adverse event was noted in any group. Conclusions Adding acarbose or metformin to insulin therapy could achieve improvements in glycemic control with similar reductions in HbA1Clevels and weight, when comparing with insulin treatment alone. Add-on acarbose to insulin therapy may exist more effectively on glucose fluctuation than that of add-on metformin, which may have important clinical implications in those patients with postprandial hyperglycemia, large blood glucose fluctuation, and intolerance to metformin.

Partial nephrectomy for T1b renal masses: comparison of laparoscopic and robot-assisted approach / 中华泌尿外科杂志

Objective To compare the operative-postoperative outcomes of laparoscopic and robotassisted partial nephrectomy (LPN and RAPN) for patients with T1 b renal masses.Methods A total of 169 T1 b renal mass patients receiving LPN (n =69) or RAPN (n =100) in our center between October 2009 and October 2017 were retrospectively collected.There were 46 males and 23 females in LPN group,with a mean age of (55.0 ± 11.9) years.The mean tumor size was (5.09 ± 0.76) cm,and mean R.E.N.A.L score was 6.36 ± 1.53.49 procedures (71％) were performed via a retroperitoneal approach in LPN group.There were 59 males and 41 females in RAPN group with a mean age of (52.9 ± 11.7) years.The mean tumor size was(4.95 ±0.66) cm,and mean R.E.N.A.L score was 8.17 ± 1.50.31 procedures (31％)were performed via a retroperitoneal approach in RAPN group.There was statistical significance between two groups in R.E.N.A.L score and surgery approach (P ＜ 0.001).The group covariates were balanced through propensity score matching (PSM) using 1∶ 1 nearest neighbor matching method.After PSM,operating time,estimated blood loss,warm ischemia time,incidence of complications,hospital stay and postoperative follow-up status were compared between LPN(n =36)and RAPN(n =36)group.Results After PSM,patient distributions were closely balanced.In the LPN vs the RAPN group,there were significant different in warm ischemia time [(23.9 ± 7.3) min vs.(20.4 ± 6.7) min,P ＜ 0.05],estimated blood loss [(136.9 ± 80.2) ml vs.(136.9 ± 80.2) ml,P ＜ 0.05],incidence of complications (8.7％ vs.1.0％,P ＜0.05),and hospital stay [(11.5 ±3.8)d vs.(9.8 ± 1.80)d].There was no significant differences resulted regarding operating time [(164.5 ± 64.4) min vs.(169.0 ± 42.5) min,P ＞ 0.05],variation of estimated glomerular filtration rate from baseline [(9.97 ± 8.98)％ vs.(9.27 ± 9.19)％,P ＞ 0.05],positive surgical margin rate (1.4％ vs.0,P ＞ 0.05) and rate of recurrence or metastasis (1.4％ vs.1.4％,P ＞ 0.05) between groups.Conclusion Considering operative,functional and oncologic outcomes,both RAPN and LPN performed by an experienced surgeon were acceptable for patients with T1b renal masses.If available,robotic approach may reduce operative trauma and complications.

Role of chemokine receptor CXCR4 in sorafenib resistance of renal cell carcinoma / 中华泌尿外科杂志

Objective To investigate the role and possible mechanism of Chemokine receptor CXCR4 in the drug resistance of sorafenib in renal cell carcinoma.Methods 786-O cells were inoculated into the anterior sciatic region of nude mice subcutaneously,5 × 106 cells per point.The mice were given normal saline and sorafenib intragastric (80 mg/kg,1 time/day) when the transplanted tumor volume reached about 100 mm3.The tumor volume in the saline group was more than 1 500 mm3 at the 5th week,and the tumor was taken as the control tissue.Sorafenib group tumors started to grow accelerately at week 8,and the tumor volume was more than 1 500 mm3 at week 13.The 13th week tumors were used as resistant tissue.The expression of CXCR4 in control tissues and drug resistant tissues was detected by real-time quantitative PCR,western blotting and immunohistochemistry.The pcDNA3.1-CXCR4 plasmid was constructed and transfected into 786-O cells.The expression of CXCR4 was detected by real-time quantitative PCR and western blotting.The drug reactivity of the cells was measured by CCK-8 and monoclonal assay to compare the drug resistance of the control group,CXCR4 overexpression group and CXCR4 overexpression + CXCR4 inhibitor AMD3100 group.The phosphorylation of PKB,ERK and STAT3 in the control group,the sorafenib alone group,the overexpressing CXCR4 + sorafenib group and the overexpressing CXCR4 + sorafenib + AMD3100 group were deternined by Western blotting.Results Compared with the control tissues,the mRNA levels of CXCR4 in the drug-resistant tissues increased (3.22 ± 0.23) times,and the levels of protein expression increased (2.33 ± 0.47) according to western blotting,the differences were statistically significant (P ＜ 0.01).After overexpression of CXCR4,the nRNA expression of CXCR4 increased (78.3 ± 5.3) times,and the protein expression level increased (2.80 ± 0.95) times,and the differences were statistically significant (P ＜ 0.01),indicating that the expression model was established successfully.The drug response curves of the control group,CXCR4 overexpression group and CXCR4 overexpression + AMD3100 group on sorafenib were measured by cck8 method,and the ICS0 was (7.5 ±0.8) μmo]/L,(10.3 ±0.7) μmol/L,(5.7 ±0.6) μmol/L,the differences were statistically significant (P ＜ 0.05);The numbers of clones formed in the above three groups were 26 ± 5,56 ± 12 and 42 ± 9,respectively.The differences were statistically significant (P ＜ 0.05).Sorafenib could reduce the phosphorylation of PKB,ERK and STAT3,and overexpression of CXCR4 could reverse the inhibition of phosphatidylation of PKB,ERK and STAT3 by sorafenib.After inhibition of chemokine receptor CXCR4 activity by AMD3100,PKB,ERK,STAT3 phosphorylation was re-suppressed.Conclusions CXCR4 can promote renal cell carcinoma sorafenib resistance.The expression of CXCR4 increased in secondary resistant tumor tissue increased;CXCR4 may promote drug resistance by activating the cell viable pathway.The inhibition of CXCR4 signaling pathway is expected to improve the therapeutic effect of sorafenib in renal cell carcinoma.

Robotic laparoendoscopic single-site (LESS) zero-ischemia partial nephrectomy: a preliminary report / 中华泌尿外科杂志

Objective This study is to explore the safety,feasibility and efficacy of robotic laparoendoscopic single-site(LESS) zero-ischemia partial nephrectomy.Methods Two patients underwent robotic laparoendoscopic single-site zero-ischemia partial nephrectomy by our urologic surgical team at 22-May-2017 and 31-May-2017 in our institution.The salient patient demographics and tumor characteristics,including age,gender,body mass index (kg/m2),Charlson Co-morbidity Index (Age-weighted),tumor laterality,diameter (cm),R.E.N.A.L.nephrometry score and preoperative split renal function GFR [ml/(min · 1.73 m2)] were:73/56,female/male,25.2/19.8,2/0,lcft/right,1.8/1.4,5a/4a,left 43.8、right 49.2/left 38.8 、right 48.7 respectively.A 2-3 cm longitudinal skin incision was made at 4 cm below the inferior margin of rib arch at the level of midaxillary line (case NO.1) or peri-umbilicus (case NO.2).The da Vinci Si robotic Single-siteTM Port was inserted.The line of Toldt was incised with the colon medially mobilized.Gerota's fascia was opened,the main renal artery or its branches were dissected,then the renal mass fully dissected and exposed.The renal mass was entirely removed with approximately 0.5-1.0 cm surrounding normal renal parenchyma (unclamping in case NO.1,and selective branch clamping in case NO.2) and kidney reconstruction was conducted with 1-0 Quill Suture via hem-o-lock sliding technique.Results The two procedures were smoothly completed without any extra skin incision.Operative duration,estimated blood loss and skin incision length was respectively 230/190 min,100/60 ml,3.6/2.5 cm.Duration of two selective renal artery branches clamping in case NO.2 was 39 and 24 min.Postoperative pain measured by the visual analog pain scale (VASP) at day 1,day 2,day 3 was 5/4,3/3,2/1,Time off oral intake,duration of drainage and length of stay after surgery was 2/4 d、2/4 d、6/7d,respectively.The recovery of both patients were uncomplicated and discharged smoothly.Pathological examination revealed oncocytoma in case NO.1 and papillary renal cell carcinoma in case NO.2.Conclusions The initial experience shows the robotic laparoendoscopic single-site zero-ischemia partial nephrectomy is a safe,feasible and efficacious procedure.It may exhibit clinical benefits for patients in terms of pain control,convalescence and cosmesis,but in this early stage the clinical indications should be strictly controlled.

The progress of studying the mechanisms of immune cells in the regulation of non-alcoholic fatty liver diseases / 中华肝脏病杂志

Non-alcoholic fatty liver diseases (NAFLD) are liver diseases which are strongly associated with obesity. The incidence of NAFLD has been gradually increased in recent years. According to different pathology of the liver, NAFLD include three disease states: simple fatty liver, hepatitis (nonalcoholic steatohepatitis, NASH) and fatty liver cirrhosis. The accumulations of fat around the internal organs, which secrete a wide range of adipokines, such as interleukin-6, contribute the development and progress of NAFLD in obesity. In addition, the liver has been recognized as an immune organ containing several immune cells, for instance, inherited macrophages in the live (kupffer cells), nature killer cells, T lymphocytes, T regulatory cells (Tregs), myeloid-derived suppressor cells (MDSCs), and dendritic cells. These immune cells secret a number of cytokines, such as tumor necrosis factor (TNF-α) and monocyte chemoattractant protein (MCP-1), play important roles in the development of NAFLD. Moreover, a high level of fatty acids in the liver microenvironment, leads to suppress CD4+T cells and the loss of CD4+T cells in the microenvironment of the liver may be one of key factors which is associated with the progress of NAFLD to cirrhosis and liver cancer. This article aims to review the recent studies in the mechanisms of these immune cells involving in the progress of NAFLD, and to explore the novel strategies targeting these immune cells to control the prevalence of NAFLD and reduce liver fibrosis.

Inhibitory effect of myricetin on the metastasis of human renal cell carcinoma / 药学实践杂志

Objective To evaluate the role of myricetin in the metastasis of human renal cancer ACHN cells both in vitro and in vivo.Methods With different concentration of myricetin (25, 50, 100 μmol/L) acting on ACHN cells, the cell viability, migration and invasion were respectively measured with CCK-8 assay, wound healing migration assay and Transwell invasion assay in vitro.A lung metastatic model for human renal cell carcinoma was developed by tail vein injection with ACHN cells.The effect of myricetin on the metastasis of renal cell carcinoma was explored by intraperitoneal injection of myricetin in vivo.After 6 weeks, the micro metastases of the lungs in nude mice was examined.Results Compared to the control group, CCK-8 assay showed that the cell viability was significantly lower in the myricetin group at the concentration of 50 μmol/L for 24 h (P=0.019).The inhibitory effect became more significant with the increase in drug concentration or action time.In addition, myricetin also inhibits the migration and invasion of ACHN cells in a dose dependent manner.Intraperitoneal injection of myricetin significantly reduced the number of the micro metastases of renal cell carcinoma in the lungs of nude mice.Conclusion Myricetin effectively inhibits the cell viability, migration and invasion of human renal cancer ACHN cells.It has the potential therapeutic value in the treatment of renal cell carcinoma.

Effects of GBE50 on Hemodynamics and TNF-α Pathway in Myocardial Tissue of Rats with Acute Blood Stasis Syndrome / 中国中医药信息杂志

Objective To observe the effects of Ginkgo biloba extract 50 (GBE50) on hemodynamics and myocardial tissue TNF-α pathway in rats with acute blood stasis syndrome; To discuss its mechanism of action. Methods A model of acute blood stasis syndrome was established by subcutaneous injection of epinephrine hydrochloride and ice bath. Male SD rats were divided randomly into normal group, model group and GBE50 group. After medicine was administrated by gavage for 11 days, the acute blood stasis model was established. The hemodynamic changes were observed in the next day. The expressions of TNF-α, TNFR1 and TNFR2 mRNA were detected by RT-PCR. The expressions of TNF-α, TNFR1 and TNFR2 protein were tested by radioimmunoassay and immunohistochemistry. Results The hemodynamics of the model group was lower than that of the normal group. Compared with model group, GBE50 could increase mLVSP, DP and decrease t-dp/dtmax(P<0.05). The protein expressions of TNF-α, TNFR1, and TNFR2 in GBE50 group were higher than those in model group, and TNFR2 mRNA expression increased significantly in GBE50 group (P<0.05). Conclusion GBE50 can ameliorate the decline of hemodynamics of rats with acute blood stasis syndrome, and regulate the myocardial TNF-α pathway. Increasing the expression of protective receptor TNFR2 may be one of the mechanisms of protecting cardiac function.

Effects of GBE50 on Hemodynamics and TNF-α Pathway in Myocardial Tissue of Rats with Acute Blood Stasis Syndrome / 中国中医药信息杂志

Objective To observe the effects of Ginkgo biloba extract 50 (GBE50) on hemodynamics and myocardial tissue TNF-α pathway in rats with acute blood stasis syndrome; To discuss its mechanism of action. Methods A model of acute blood stasis syndrome was established by subcutaneous injection of epinephrine hydrochloride and ice bath. Male SD rats were divided randomly into normal group, model group and GBE50 group. After medicine was administrated by gavage for 11 days, the acute blood stasis model was established. The hemodynamic changes were observed in the next day. The expressions of TNF-α, TNFR1 and TNFR2 mRNA were detected by RT-PCR. The expressions of TNF-α, TNFR1 and TNFR2 protein were tested by radioimmunoassay and immunohistochemistry. Results The hemodynamics of the model group was lower than that of the normal group. Compared with model group, GBE50 could increase mLVSP, DP and decrease t-dp/dtmax(P<0.05). The protein expressions of TNF-α, TNFR1, and TNFR2 in GBE50 group were higher than those in model group, and TNFR2 mRNA expression increased significantly in GBE50 group (P<0.05). Conclusion GBE50 can ameliorate the decline of hemodynamics of rats with acute blood stasis syndrome, and regulate the myocardial TNF-α pathway. Increasing the expression of protective receptor TNFR2 may be one of the mechanisms of protecting cardiac function.