Study on the changes of HPLC fingerprints and main chemical compounds before and after the compatibility of Salvia miltiorrhiza and Salvia miltiorrhiza / 国际中医中药杂志

Objective:To establish methods for HPLC fingerprints and simultaneous determination of multi-index components before and after compatibility of Salvia miltiorrhiza and Angelica sinensis, so as to analyze the dissolution rate of the main compounds. Methods:The extracts of Salvia miltiorrhiza, Angelica sinensis and their compatibility were prepared. The separation was performed on an Eclipse XDB-C18 column (4.6 mm×250 mm,5 μm), mobile phase with 0.1% phosphoric acid aqueous solution-acetonitrile for gradient elution, flow rate at 1.0 ml/min, column temperature was maintained at 35 ℃, and the detection wavelength was set at 280 nm. The HPLC fingerprint were established before and after the compatibility of Salvia miltiorrhiza and Angelica sinensis, and the shared patterns of the fingerprint were obtained to gain chromatographic peaks. The content of 9 components Danshensu, caffeic acid, rosmarinic acid, salvianolic acid B, salvianolic acid A, tanshinone Ⅱ A, ferulic acid, chlorogenic acid and Yangchuanxiong lactone were determinated, and the changes of dissolution rate of each compound before and after the compatibility were analyzed. Results:The determination method for the multi- components with HPLC is precise and the components (waiting to be determinate) in the solution were stable within 48 hours, and the RSD values of each chromatographic peak were <5.0%. The nine components showed good linear relationships within their own ranges, and the recovery rate was in compliance with regulations. The fingerprint similarities of each sample were ?0.9. After the compatibility of Salvia miltiorrhiza and Angelica sinensis, a total of seventeen common peaks were calibrated, ten of which were from Salvia miltiorrhiza, seven from Angelica sinensis. No new components was found under this chromatographic condition. After the combination of these two material medicica decoction, the average dissolution rates of rosmarinic acid, salvianolic acids and Danshensu in Salvia miltiorrhiza were significantly lower than those of the single decoction group ( P<0.05 or P<0.01); the average dissolution rates of caffeic acid in Salvia miltiorrhiza was significantly higher than that of the single decoction group ( P<0.01); the average dissolution rates of chlorogenic acid and ferulic acid in Angelica sinensis were significantly higher than that of the single decoction group ( P<0.05 or P<0.01); the average dissolution rate of Yangchuanxiong lactone after the compatibility was not statistically different than that of single decoction group. Conclusion:The characteristic peaks of HPLC fingerprint of the compatibility of Salvia miltiorrhiza and Angelica sinensis did not increase under this chromatographic condition, which had a significant effect on the dissolution of index components.

The Effect of Matrix Remodeling Associated 7 (MXRA7) Expression on the Biological Function of SHI-1 Cells / 中国实验血液学杂志

OBJECTIVE@#To express matrix remodeling associated 7 (MXRA7) in the human acute myeloid leukemia SHI-1 cell line and to assess the role of MXRA7 in the biological function of SHI-1 cells.@*METHODS@#The full-length cDNA sequence of human MXRA7 was synthesized and subcloned into the lentivirus shuttle vector pRRL-Venus. SHI-1 cells were transfected with the lentivirus which was packaged with 293T cells. The YFP-positive cells were sorted by flow cytometry and the stable cell lines were obtained by expanded culture. The expression and distribution of MXRA7 in SHI-1 cells were verified by real-time qPCR, Western blot and laser confocal techniques. Cell proliferation and cell cycle were measured by flow cytometry, and apoptosis was determined by Annexin V and 7-AAD staining. The expression of apoptosis related proteins were detected by Western blot.@*RESULTS@#The stable SHI-1 cell line overexpressing MXRA7 was established successfully. Laser confocal analysis confirmed that MXRA7 was expressed in the cytoplasm of SHI-1 cells. Compared with the control cell line, the overexpression of MXRA7 showed no effect on the cell proliferation and cell cycle, but reduced the percentage of apoptosis cells induced by methotrexate. Moreover, the expression of BCL-2 protein was increased by overexpression of MXRA7, which can inhibit cell apoptosis.@*CONCLUSION@#The SHI-1 stable cell line overexpressing MXRA7 was established successfully, and MXRA7 could inhibit drug-induced apoptosis through increasing the expression of BCL-2 protein.

Current research status on pelvic autonomic nerve monitoring in rectal cancer surgery / 中华胃肠外科杂志

Rectal cancer is a common malignant tumor of the digestive tract, and surgery is the main treatment strategy. Disorders of bowel, anorectal and urogenital function remain common problems after total mesorectal resection (TME), which seriously decreases the quality of life of patients. Surgical nerve damage is one of the main causes of the complications, while TME with pelvic autonomic nerve preservation is an effective way to reduce the occurrence of adverse outcomes. Intraoperative nerve monitoring (IONM) is a promising method to assist the surgeon to identify and protect the pelvic autonomic nerves. Nevertheless, the monitoring methods and technical standards vary, and the clinical use of IONM is still limited. This review aims to summarize the researches on IONM in rectal and pelvic surgery. The electrical nerve stimulation technique and different methods of IONM in rectal cancer surgery are introduced. Also, the authors discuss the limitations of current researches, including methodological disunity and lack of equipment, then prospect the future direction in this field.

The clinical value of dynamic monitoring of serum heparin binding protein, procalcitonin and IL-18 in evaluating the severity of acute pancreatitis / 中华肝胆外科杂志

Objective:To investigate the correlations between level of serum heparin binding protein (HBP), procalcitonin (PCT), interleukin-18 (IL-18) and the severity of acute pancreatitis (AP).Methods:A total of 86 patients with AP admitted to the First Affiliated Hospital, University of Science and Technology of China from December 2017 to May 2019 were included and divided into mild AP group (MAP) with 36 cases, moderate AP group (MSAP) with 26 cases, and severe AP group (SAP) with 24 cases. There were 25 healthy subjects were chosen as the control group. Serum HBP, PCT, and IL-18 levels were dynamically monitored in all patients at 1, 3 and 7 days after admission. The Spearman correlation analysis was conducted to detect the correlation between the three indicators and inflammatory factors IL-6, IL-8, TNF-α, and APACHEII and Ranson score, and analyzed the early diagnostic value of HBP, PCT, and IL-18 in SAP patients.Results:In 86 AP patients, 53 were males and 33 were females, aged (48.3±8.0) years. In 25 healthy subjects, 15 were males and 10 were females, aged (40.5±5.9) years. Serum levels of HBP, PCT and IL-18 in AP patients were significantly higher than those of healthy control group at 1, 3 and 7 days after admission ( P<0.05), and the most significant increase was observed on the 1st day. At the meanwhile, HBP, PCT, and IL-18 were positively correlated with level of IL-6, IL-8, TNF-α, APACHEII and Ranson scores ( P<0.05). The AUC area of SAP diagnosis by using HBP, PCT or IL-18 alone was respectively 0.825, 0.896, 0.799, the Yoden index was respectively 0.605, 0.628, 0.583, the sensitivity and specificity were 75.3%, 76.2%, 74.8% and 85.2%, 86.6%, 83.5%. The AUC area, Yoden index, sensitivity and specificity of joint detection were 0.923, 0.787, 85.5%, 93.2%, and the positive predictive value and negative predictive value were also increased. Conclusion:Monitoring of serum HBP, PCT and IL-18 can predict the severity of AP patients, and it may serve as an early diagnostic marker for AP.

New bisabolane-type phenolic sesquiterpenoids from the marine sponge Plakortis simplex / 中国天然药物

Six new bisabolane-type phenolic sesquiterpenoids, including plakordiols A-D (1-4), (7R, 10R)-hydroxycurcudiol (5) and (7R, 10S)-hydroxycurcudiol (6) were isolated from the marine sponge Plakortis simplex collected from the South China Sea. Their structures were determined based on extensive analysis of spectroscopic data. Their configurations were assigned by coupling constant analysis, NOESY correlations, and the modified Mosher's method. Furthermore, their cytotoxic and antibacterial activities were evaluated.

Effect of Pain Relief on Gait Characteristics of Patients with Chronic Nonspecific Low Back Pain / 中国康复理论与实践

Objective:To observe the effects of pain relief after acupuncture on walking speed, step length and ground reaction force (GRF) of patients with chronic nonspecific low back pain (CNLBP) during walking. Methods:From May to December, 2019, 28 CNLBP patients were randomly divided into waiting list group (n = 14) and acupuncture group (n = 14). The acupuncture group received acupuncture, 30 minutes a time, three times a week, for four weeks. The waiting list group only received health education after enrollment until four weeks later. Gait analysis was performed with three-dimensional motion system for both groups after enrollment and one month later. The walking speed, step length and GRF characteristic values were recorded and compared, as well as Visual Analogue Score (VAS) for pain. Results:After intervention, The VAS decreased in both groups (t > 2.956, P < 0.05), and was lower in the acupuncture group than in the waiting list group (t = -2.844, P = 0.004). No significant difference in walking speed, step length and GRF characteristic values was found after intervention in both groups (P > 0.05). Conclusion:One month-acupuncture could relief the pain of CNLBP patients, however, it could not improve the performance during walking.

Application of computer navigation in total knee Arthroplasty / 中国组织工程研究

BACKGROUND: With the development of precision medicine, knee replacement under navigation has been paid more and more attention. Precision medicine allows for more accurate implant placement and better limb alignment. However, precision medicine can also make surgery much longer. OBJECTIVE: To evaluate the application of Aesculap Ortho-Pilot non-image-dependent wireless navigation in total knee arthroplasty. METHODS: Data of 42 patients with unilateral knee osteoarthritis admitted to the First Affiliated Hospital of Anhui Medical University from April to November 2017 were retrospectively collected. First total knee arthroplasty was conducted by the same surgeon. According to surgical methods, the patients were divided into two groups: The navigation group (n=21) received a total knee arthroplasty under the assistance of Ortho-Pilot non-image-dependent wireless navigation, and the non-navigation group (n=21) received a regular total knee arthroplasty. Operation time and drainage volume were recorded in both groups. X-ray film of weight bearing was taken 12 months after operation. Mechanical axis of the lower extremity, the mechanical proximal medial proximal angle of the mechanical shaft of the tibia, the distal lateral angle of the femoral mechanical axis, sagittal tibial component angle and the number of alignment deviation of the lower extremity (>3°) were compared between the two groups. Knee range of motion and Hospital for Special Surgery knee score were evaluated. This study was approved by the Ethics Committee of First Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Operation time was longer in the navigation group than in the non-navigation group (P 3° and the variables of medial angular separation of proximal end of the mechanical axis of the tibia between the two groups (P > 0.05). (3) At postoperative 12 months, the range of motion was larger in the navigation group than in the non-navigation group (P 0.05). (4) Results suggested that total knee arthroplasty assisted by computer navigation can improve the accuracy of lower limb alignment, accuracy of prosthesis placement and knee range of motion. However, the operation time was improved, so the advantages and disadvantages should be considered comprehensively.

Clinical efficacy of the modified Helicobacter pylori eradication therapy for Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: a meta analysis / 中华医学杂志(英文版)

BACKGROUND@#Helicobacter pylori (HP) has been considered to be one of the primary causes of gastric mucosa-associated lymphoid tissue (MALT) lymphoma since 1993. Low-grade gastric MALT lymphoma with HP is widely treated with HP eradication therapy, according to each specific clinical situation. However, several studies and guidelines indicate that the modified HP eradication therapy is also valid for HP-negative gastric MALT lymphoma. The aim of this study was to perform a meta-analysis of the clinical efficacy of the modified HP eradication therapy for gastric MALT lymphoma without HP.@*METHODS@#We searched studies that reported the response rate of the modified HP eradication therapy regimen for gastric MALT lymphoma without HP by using PubMed, Medline, and Ebsco from January 1971 until February 2019. All statistical analyses were carried out using R 3.5.3 (Mathsoft Company, Cambridge, MA, USA). The pooled response rate was expressed as a decimal. The heterogeneity test was performed using the I-squared (I) statistic.@*RESULTS@#A total of 14 studies were selected with a total of 148 patients with HP-negative gastric MALT lymphoma. The overall pooled response rate was 0.38 (95% confidence interval [CI]: 0.29-0.47). The combined estimate is I = 57% (P < 0.01). The study subjects were categorized by factors (area of patients). The pooled response rate of the sub-groups (Korea, Japan, China, and Western countries) was 0.63 (95% CI: 0.50-0.76), 0.16 (95% CI: 0.05-0.30), 0.38 (95% CI: 0.20-0.55), and 0.57 (95% CI: 0.08-1.00). The response rate showed that the modified HP eradication therapy was effective for patients with HP-negative gastric MALT lymphoma, especially in Korea and Western countries.@*CONCLUSION@#Therefore, the modified HP eradication therapy can be considered an optional therapy for patients with low-grade HP-negative gastric MALT lymphoma. However, several limitations were revealed in the meta-analysis. Further systematic reviews and research are required.

Sleep-related symptoms in multiple system atrophy: determinants and impact on disease severity / 中华医学杂志(英文版)

BACKGROUND@#Sleep disorders are common but under-researched symptoms in patients with multiple system atrophy (MSA). We investigated the frequency and factors associated with sleep-related symptoms in patients with MSA and the impact of sleep disturbances on disease severity.@*METHODS@#This cross-sectional study involved 165 patients with MSA. Three sleep-related symptoms, namely Parkinson's disease (PD)-related sleep problems (PD-SP), excessive daytime sleepiness (EDS), and rapid eye movement sleep behavior disorder (RBD), were evaluated using the PD Sleep Scale-2 (PDSS-2), Epworth Sleepiness Scale (ESS), and RBD Screening Questionnaire (RBDSQ), respectively. Disease severity was evaluated using the Unified MSA Rating Scale (UMSARS).@*RESULTS@#The frequency of PD-SP (PDSS-2 score of ≥18), EDS (ESS score of ≥10), and RBD (RBDSQ score of ≥5) in patients with MSA was 18.8%, 27.3%, and 49.7%, respectively. The frequency of coexistence of all three sleep-related symptoms was 7.3%. Compared with the cerebellar subtype of MSA (MSA-C), the parkinsonism subtype of MSA (MSA-P) was associated with a higher frequency of PD-SP and EDS, but not of RBD. Binary logistic regression revealed that the MSA-P subtype, a higher total UMSARS score, and anxiety were associated with PD-SP; that male sex, a higher total UMSARS score, the MSA-P subtype, and fatigue were associated with EDS; and that male sex, a higher total UMSARS score, and autonomic onset were associated with RBD in patients with MSA. Stepwise linear regression showed that the number of sleep-related symptoms (PD-SP, EDS, and RBD), disease duration, depression, fatigue, and total Montreal Cognitive Assessment score were predictors of disease severity in patients with MSA.@*CONCLUSIONS@#Sleep-related disorders were associated with both MSA subtypes and the severity of disease in patients with MSA, indicating that sleep disorders may reflect the distribution and degree of dopaminergic/non-dopaminergic neuron degeneration in MSA.

The gait patterns of youths with chronic, nonspecific low back pain / 中华物理医学与康复杂志

Objective:To quantify the kinematic changes in the gait cycle among youths with chronic, nonspecific low back pain (CNLBP).Methods:A Qualisys 3D optical motion capture system was used to document the gait kinematics of 11 youths with CNLBP and 11 healthy counterparts. Gait profile scores and movement analysis profiles were then calculated.Results:The young CNLBP subjects exhibited gait abnormalities, as reflected by the significant difference of the gait variable the range of motion of the dominant knee between the CNLBP and healthy groups [(5.66±1.83)° vs (3.64±1.13)°]. Gait profile scores and movement analysis profiles are applicable to evaluating them.Conclusions:There manifested gait abnormalities in youth CNLBP patients. Gait profile scores and movement analysis profiles are applicable to evaluating them.

Advance in Surface Electromyography for Chronic Low Back Pain (review) / 中国康复理论与实践

Surface electromyography can record the neuroelectric signals responding the activity of muscle during exercise, which has been used to observe the characteristics of trunk and lower limb muscles in patients with chronic low back pain. It may be used in the researches about pathogenesis, diagnosis and treatment of chronic low back pain by comparing the surface electromyography signals between patients and normal controls during various activities.

Application and prospect of fecal DNA test in colorectal cancer screening / 中华胃肠外科杂志

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.

Short-term outcomes of patients treated with enhanced recovery after surgery combined with laparoscopic colorectal cancer surgery / 中华普通外科杂志

Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) used in laparoscopic colorectal cancer surgery.Methods We conducted a retrospective analysis of the medical records of 99 cases treated with ERAS programed laparoscopic colorectal cancer surgery (ERAS group) and 103 cases treated with traditional perioperative care and laparoscopic colorectal cancer surgery (controlled group) from Mar 2017 to Sep 2017 in our center.Results There was no significant difference in age,gender,BMI,ASA classification,tumor location,operation time,pathological stage and the incidence of postoperative complications between ERAS group and controlled group (all P ＞ 0.05).Compared to control group,ERAS had less blood loss,shorter time to pass first flatus,stool and start diet and shorter hospitalization day,with all the difference statistically significant [(60 ± 63)ml vs.(112 ± 245)ml,(3.0±0.8)dvs.(4.3 ±1.2)d,(3.5 ±1.0)dvs.(4.6±1.3)d,(4.1 ±1.2)dvs.(5.4± 2.0)d,(5.8±2.1)dvs.(7.8±2.5)d,t=-2.021、-9.216、-6.887、-5.252、-6.163,allP＜ 0.05].No patients in both groups suffered from readmission or death within 30 days after surgery.Conclusion Patients treated with ERAS programed laparoscopic colorectal cancer surgery is safe and effective,with rapid recovery and reduced hospital stay.

Comprehensive evaluation of medullary thyroid carcinoma before surgery / 中华医学杂志(英文版)

BACKGROUND@#Medullary thyroid carcinoma (MTC) is a rare disease, but it exhibits more aggressive behaviors. The aim of this study was to improve the diagnostic accuracy of MTC before surgery by analyzing the clinical and ultrasonic data of patients with MTC.@*METHODS@#The study included 71 patients (96 lesions) with histopathologically proven MTC between April 2011 and September 2016 in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. The clinical characteristics and sonographic findings were retrospectively reviewed and compared between the ultrasonic correct diagnosis group and the ultrasonic misdiagnosis group with the t test or Mann-Whitney U test for quantitative parameters and the χ test or Fisher exact test for qualitative parameters.@*RESULTS@#Compared with the ultrasonic correct diagnosis group, the proportion of the cystic change in the ultrasonic misdiagnosed group was high (25.0% vs. 4.2%), the uncircumscribed margin and irregular shape proportions were low (20.8%, 58.3% vs. 74.7%, 87.3%), calcification was relatively rare (20.8% vs. 56.3%), and rich vascularity was relatively rare (25.0% vs. 78.9%).@*CONCLUSIONS@#In the case of atypical MTC, such as cystic change, circumscribed margin, regular shape, no calcification, no rich vascularity, and normal cervical lymph nodes, MTC is easily misdiagnosed as benign by ultrasound. Therefore, ultrasound, cytology and serum calcitonin should be comprehensively evaluated for a preoperative diagnosis of MTC.

Role of high mobility group box - 1 protein in pathogenesis of acute kidney injury induced by heat stroke in mice / 中华肾脏病杂志

Objective To observe the differential expression of high mobility group box - 1 protein (HMGB1) in renal tissues of heat stroke mice models, and to explore its role in the pathogenesis of heat stroke associated acute kidney injury(HS-associated AKI). Methods According to random number table, 20 healthy male C57BL/6J mice were randomly divided into 2 groups, including normal control (n=10) and heat stroke group (n=10). The mice in heat stroke group were given with a 2-hour-exposure in biological simulation chamber (temperature 41℃, humidity 70％). Heat stroke was defined as anal temperature lasting more than 40 degrees Celsius. A 18F - deoxyglucose nuclide labeled vivo imaging was conducted with micro - positron emission tomography(PET)/computer tomography (CT). Serum creatinine was examined with blood example. In order to evaluate the pathological changes, HE stain was conducted with kidney tissue, and mitochondrial morphological changes in kidney tissue were observed by transmission electron microscopy. The expressions of HMGB1 and apoptosis inducing factor mitochondria associated 2 (Aifm2) were examined by immunohistochemical method, and the levels of HMGB1 and RAGE were examined by Western blotting. The cell apoptosis of renal tissue was detected by terminal deoxynucleotidyl transferase -mediated dUTP - biotin nick end labeling assay (TUNEL). The metabolomics of kidney tissue in mice were detected by liquid chromatography - mass spectrometry (LC - MS), and the pathway enrichment analysis was carried out by KEEG database. Results (1) The body temperature of the mice in heat shock group was significantly higher than that in normal control group 45 min after model establishment (P＜0.05). The level of serum creatinine in heat shock group was significantly higher than that in normal control group (P＜0.05), and the levels of 18F - deoxyglucose increased in skeletal muscle and visceral tissue of the mice in heat - shock group. (2) HE staining showed hemorrhage in collecting duct and tubular endothelial cell swelling, and mitochondrial swelling and deformation were observed by transmission electron microscopy in kidney tissue of the heat shock group. (3) Immunohistochemical method showed that the levels of Aifm2 and HMGB1 in heat shock group were higher (P＜0.05). (4) Western blotting showed that the levels of HMGB1 and RAGE in heat shock group were higher than those in normal control group (P＜0.05). (5) TUNEL showed that the number of cells with positive stain in kidney tissue of the heat shock group was higher than that in normal control group (P＜0.05). (6) Between normal control group and heat shock group, 136 differential metabolites were detected in kidney tissues. After analysis by KEGG database, pathway abnormalities such as unsaturated fatty acid metabolism disorder may be associated with HS - associated AKI, and many differential metabolites such as adrenic acid may be important regulatory points in the pathogenesis. Conclusion Acute kidney injury is a common complication of heat shock. It may be related to the dysfunction of renal mitochondria and activation of apoptotic pathway caused by systemic hypercatabolism, which may be related to the disorder of unsaturated fatty acid metabolism and activation of HMGB1. Some differential metabolites may be of high value in HS- associated AKI studies.

Researches of Three-dimensional Gait Analysis for Chronic Nonspecific Low Back Pain (review) / 中国康复理论与实践

At present, three-dimensional gait analysis has been used in the diagnosis, treatment and rehabilitation of chronic non-specific low back pain. Existing researches have conducted systematic cross-sectional studies on the gait of patients with chronic non-specific low back pain from the aspects of space-time parameters, kinematics parameters, dynamic parameters and surface EMG, but few are about efficacy evaluation with three-dimensional gait analysis, which may be a topic in the future.

Research status of multiple primary carcinoma / 肿瘤研究与临床

With the improvement of living standard and the change of diet structure,the incidence of multiple primary carcinoma has increased significantly,which is related to the improvement of diagnosis level.In clinical work,multiple primary carcinoma was easily misdiagnosed with metastatic cancer.Many patients lost their best time to treat,because principles and prognosis of them were distinctly different.Strengthen the understanding of multiple primary carcinoma,in order to detect,diagnose and treat earlier,is beneficial to improve the survival of patients.Based on this background,this article reviewed the epidemiology,etiology,pathogenesis,diagnosis and treatment strategies of multiple primary carcinoma,aiming at improving the prognosis of patients.

Impact of previous abdominal surgery on the outcomes of laparoscopic resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of previous abdominal surgery(PAS) on laparoscopic resection of colorectal cancer.</p><p><b>METHODS</b>The retrospective cohort study was adopted.Clinical data of consecutive colorectal cancer patients with PAS history (past history of at least one abdominal surgery, exclusion of previous inguinal hernia repair, simple laparoscopic approach, appendectomy of the right lower quadrant and endoscopic therapy) undergoing laparoscopic surgery at the Cancer Hospital of Chinese Academy of Medical Sciences between 2010 and 2015 were collected, meanwhile other colorectal cancer patients without PAS history were selected according to 1 to 1 match in age, sex, body mass index, American Society of Anesthesiologists score, tumor location, type of surgery, and staging of tumor. A total of 464 pairs were successfully matched. Intraoperative and postoperative conditions, perioperative complications and prognosis were compared between the two groups.</p><p><b>RESULTS</b>In PAS group, there were 341 males (73.5%) and 123 females (26.5%) with a median age of 62 (24-85) years; 317(68.3%) cases with only one previous abdominal surgery and 147(31.7%) with more than one; 389(83.8%) cases with abdominal midline incisions, 37(8.0%) with transverse incisions, 34(7.3%) with right subcostal incision and 4(0.9%) with left subcostal incision; 146(31.5%) cases undergoing gynecologic surgery, 84(18.1%) cholecystectomy, 52(11.2%) gastroduodenal surgery, 89(19.2%) colorectal surgery, 11(2.4%) small intestine surgery, 23(5.0%) hapatectomy, 16(3.4%) pancreatic surgery, 8(1.7%) urological surgery, 18(3.9%) retroperitoneal tumor resection and 1(0.2%) other surgery. In no PAS group, there were 328 males (70.7%) and 136 females (29.3%) with a median age of 62(24-86) years. No significant differences in baseline data were found between the two groups (all P>0.05). As compared to no PAS group, PAS group had longer mean operative time [(208.0±27.0) minutes vs. (179.0±15.3) minutes, t=4.695, P=0.003] and higher rate of conversion to laparotomy [18.1%(84/464) vs. 11.6%(54/464), χ=7.217, P=0.003]. In the PAS group, conversion to laparotomy was more common due to adhesion reaction [8.8%(41/464) vs. 4.5%(21/464), χ=4.886, P=0.007]. There were no significant differences between the two groups in intraoperative bleeding and transfusion, lymph node dissection, circumferential margin and surgical margin, time to the first diet and postoperative hospital stay(all P>0.05). No significant differences in intraoperative and postoperative morbidity of complication were found between PAS group and no PAS group [3.7%(17/464) vs. 2.8%(13/464), P=0.346; 20.3%(94/464) vs. 18.5%(86/464), P=0.739]. Median follow-up of the whole patients was 32.0(0.5-79.0) months, and there was no significant difference between the two groups [PAS group 31.0(0.5-79.0) months vs. no PAS group 33.0(1.0-75.0) months, P=0.391]. In PAS and no PAS group, the 3-year disease-free survival rate was 68.1%(95%CI: 62.0%-74.2%) and 68.5%(95%CI: 63.0%-74.0%)(P=0.764), and 3-year overall survival rate was 78.5%(95%CI: 72.8%-81.4%) and 80.2%(95%CI:74.3%-86.1%)(P=0.528) respectively, whose differences were not significant.</p><p><b>CONCLUSION</b>Except higher risk of conversion to laparotomy due to adhesion reaction, laparoscopic resection of colorectal cancer is safe and feasible in patients with PAS, and the prognosis is not affected by PAS.</p>

Familial Nonmedullary Thyroid Carcinoma: A Retrospective Analysis of 117 Families / 中华医学杂志(英文版)

<p><b>Background</b>The first and most important step in characterizing familial nonmedullary thyroid carcinoma (NMTC) is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease.</p><p><b>Methods:</b>We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups: families with two affected members and families with ≥3 affected members.</p><p><b>Results:</b>The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group (P < 0.05). These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members' group and the sporadic group was incidence of multifocality (P < 0.05). The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases (14.46% vs. 5.27%; P = 0.001), while the probability in patients from families with two affected members was similar to that in sporadic patients (6.35% vs. 5.27%; P = 0.610). The Kaplan-Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups (85.54% vs. 93.65%; P = 0.045).</p><p><b>Conclusions:</b>Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.</p>

Clinical Reasoning Training Learned from Physical Therapy Programs in the USA / 中国康复理论与实践

Clinical reasoning training is the manifestation of comprehensive performance in the students of physical therapy.Strength-ening the clinical-oriented curriculum system,facilitating evidence-based practice knowledge and skills,introducing specialization educa-tion,and applying continuously the evaluation instruments of students'performance in clinical reasoning training would contribute to better education outcome.