Clinical analysis of inflatable video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy / 中华外科杂志

Objective: To examine the safety and effectiveness of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE). Methods: Totally 269 patients admitted to the Anhui Provincial Hospital of Anhui Medical University who underwent IVMTE (IVMTE group, n=47) or thoracoscopy combined with minimally invasive Mckeown esophageal cancer resection (MIME group, n=222) from September 2017 to December 2021 were analyzed retrospectively. There were 31 males and 16 females in IVMTE group, aged (68.6±7.5) years (range: 54 to 87 years). There were 159 males and 63 females in MIME group, aged (66.8±8.8) years (range: 42 to 93 years). A 1∶1 match was performed on both groups by propensity score matching, with 38 cases in each group. The intraoperative conditions and postoperative complication rates of the two groups were compared by t test, Wilcoxon rank, χ2 test, or Fisher exact probability method. Results: Patients in IVMTE group had less intraoperative bleeding ((96.0±39.2) ml vs. (123.8±49.3) ml, t=-2.627, P=0.011), shorter operation time ((239.1±47.3) minutes vs. (264.2±57.2) minutes, t=-2.086, P=0.040), and less drainage 3 days after surgery (85(89) ml vs. 675(573) ml, Z=-7.575, P<0.01) compared with that of MIME group. There were no statistically significant differences between the two groups in terms of drainage tube-belt time, postoperative hospital stay, and lymph node dissection stations and numbers (all P>0.05). The incidence of Clavien-Dindo grade 1 to 2 pulmonary infection (7.9%(3/38) vs. 31.6%(12/38), χ²=6.728, P=0.009), total complications (21.1%(8/38) vs. 47.4%(18/38), χ²=5.846, P=0.016) and total lung complications (13.2%(5/38) vs. 42.1%(16/38), χ²=7.962, P=0.005) in the IVMTE group were significantly lower. Conclusion: Inflatable video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopic esophagectomy is safe and feasible, which can reach the same range of oncology as thoracoscopic surgery.

Comparative analysis of laser confocal microscopy and corneal smear in the diagnosis of fungal keratitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To comparatively analyze the application of laser confocal microscopy and corneal smear in the diagnosis of fungal keratitis.METHODS: Totally 77 patients (77 eyes) diagnosed as fungal keratitis were selected.Laser confocal microscopy and corneal smear examination were performed to observe the characteristics of the images, and the detection rate of fungus were compared between the two methods.RESULTS: Of the 77 patients, 66 eyes (86%) were positive and 11 eyes were negative detected by laser confocal microscopy;51 eyes (66%) were positive and 26 eyes were negative detected by corneal smear examination, the difference was statistically significant compared between two group (P<0.05).CONCLUSION: Laser corneal confocal microscopy is relatively safe and sensitive.If combined the application of laser corneal confocal microscopy and corneal smear examination in clinical, the diagnosis rate of fungal keratitis may be improved.

Multiple Functions of Ten-eleven Translocation 1 during Tumorigenesis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Aberrant expression of ten-eleven translocation 1 (TET1) plays a critical role in tumor development and progression. We systematically summarized the latest research progress on the role and mechanisms of TET1 in cancer biology.</p><p><b>DATA SOURCES</b>Relevant articles published in English from 1980 to April 2016 were selected from the PubMed database. The terms "ten-eleven translocation 1," "5mC," "5hmC," "microRNA," "hypoxia," and "embryonic stem cell" were used for the search.</p><p><b>STUDY SELECTION</b>Articles focusing on the role and mechanism of TET1 in tumor were reviewed, including clinical and basic research articles.</p><p><b>RESULTS</b>TET proteins, the key enzymes converting 5-methylcytosine to 5-hydroxymethylcytosine, play vital roles in DNA demethylation regulation. Recent studies have shown that loss of TET1 is associated with tumorigenesis and can be used as a potential biomarker for cancer therapy, which indicates that TET1 serves as tumor suppressor gene. Moreover, besides its dioxygenase activity, TET1 could induce epithelial-mesenchymal transition and act as a coactivator to regulate gene transcription, such as developmental regulator in embryonic stem cells (ESCs) and hypoxia-responsive gene in cancer. The regulation of TET1 is also correlated with microRNA in a posttranscriptional modification process. Hence, it is complex but critical to comprehend the mechanisms of TET1 in the biology of ESCs and cancer.</p><p><b>CONCLUSIONS</b>TET1 not only serves as a demethylation enzyme but also plays multiple roles during tumorigenesis and progression. More studies should be carried out to elucidate the exact mechanisms of TET1 and its associations with cancer before considering it as a therapeutic tool.</p>

Scraping technique of stuck needle at Anmian point in the treatment of insomnia: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the efficacy difference in the treatment of insomnia between scraping technique of stuck needle and conventional acupuncture at Anmian (Extra).</p><p><b>METHODS</b>One hundred and thirty one cases were randomized into an Anmian group (68 cases) and a conventional acupuncture group (63 cases). In the Anmian group, Anmian (Extra) was selected. After arrival of qi, the stuck needling was adopted by rotating the needle gently in single direction, 2-3 rounds till the needle body was stuck tightly. Afterwards, the needle tail was touched gently with the index finger to fix the needle body and the needle handle was scraped gently with the thumbnail from bottom to up. The needle was retained for 30 min. In the conventional acupuncture group, Sanyinjiao (SP 6), Shenmen (HT 7) and Baihui (GV 20) were selected and stimulated with reducing technique by rotating the needles. The needles were retained for 30 min. The treatment was given once every day, continuously for 2 weeks in both groups. The score of each factor and the total score in Pittsburgh sleep quality index (PSQI) were assessed before and after treatment in the two groups. Additionally, the efficacies of two groups were evaluated.</p><p><b>RESULTS</b>For the patients in the conventional acupuncture group, the sleep quality and time of falling into spleen after treatment were improved as compared with those before treatment (all P < 0.01). The improvement of sleep time, sleep efficiency, sleep disturbance, hypnotic drug and daytime dysfunction, and PSQI total score did not present statistically significant difference as compared with those before treatment (all P > 0.05). After treatment, for the patients in the Anmian group, the factor score and total score in PSQI were apparently improved as compared with those before treatment (P < 0.01, P < 0.05). And the improvements of the above items were superior to the conventional acupuncture group (P < 0.01, P < 0.05). The total effective rate was 91.2% (62/68) in the Anmian group and was 74.6% (47/63) in the conventional acupuncture group. The clinical efficacy in the Anmian group was apparently superior to the conventional acupuncture group.</p><p><b>CONCLUSION</b>The scraping technique of stuck needle at Anmian (Extra) achieves the superior effect on insomnia as compared with the conventional acupuncture.</p>

Efficacy of intravenous zoledronic acid in the prevention and treatment of osteoporosis: a meta-analysis

OBJECTIVE@#To compare the effect of zoledronic acid in treatment and prevention of osteoporosis with placebo.@*METHODS@#Random control trials regarding zoledronic acid in treatment of osteoporosis were retrieved by selecting Medline, EMbase and Pubmed databases till April 2012. The RevMan software was used for all of the statistical analysis.@*RESULTS@#A total of 9 trials were included in this meta-analysis. The pooled effect showed that zoledronic acid could increase the bone mineral density by 2.98 times compared with placebo, and reduce the rate of fracture in patients by 32%. The results should the zoledronic acid intervention had significantly less serious adverse events than controls, and the odds ratio was 0.81 (0.76-0.87). The longer term intervention, more than 12 months intervention, could gain a better prevention effect for osteoporosis (OR, 95%CI for BMD was 3.35, 2.77-3.92; for fracture was 0.67, 0.54-0.82).@*CONCLUSIONS@#This present study shows that zoledronic acid could be effective approach in the prevention of osteoporosis, and could increase the bone mineral density and reduce the risk of fracture.

Expression changes of brain natriuretic peptide in brain tissues of rats after focal cerebral ischemia-reperfusion / 中华神经医学杂志

Objective To investigate the changes of brain natriuretic peptide (BNP) level in the　brain tissues of rats after focal ischemia-reperfusion. Methods Mature male Wistar rats were　randomly divided into sham-operated and ischemia-reperfusion groups. Focal cerebral　ischemia-reperfusion rat models in the ischemia-reperfusion group were established using Longa's　suture-occluded method.And the 2 groups were sub-grouped into 0,3,6,9,12,24,48 and 72 h,and 1and 2 w observation groups according to different times after ischemia-reperfusion. The pathological　changes in the brain tissues were observed by HE staining and immunohistochemistry. Results HE　staining indicated that neuron degeneration,necrosis and tissue edema could be seen in the brain tissues　of rats after ischemic-reperfusion. The BNP levels in the ischemic-reperfusion sub-groups were　significantly higher than those in the sham-operative sub-groups at corresponding time points (P＜0.05);and the peak level of edema and BNP expression appeared at 48 h after reperfusion. Conclusion The　expression of BNP in the brain tissues of rats after focal cerebral ischemia-reperfusion increases,which　might be related to the cerebral edema.

Surgical strategies for epidural hematoma straddling the transverse sinus: clinical analysis of 58 cases / 中华神经医学杂志

Objective To analyze the clinical management, surgical indications and surgical approaches for epidural hematoma straddling the transverse sinus. Methods The clinical data were collected from 58 patients with epidural hematoma straddling the transverse sinus treated between September, 2001 and December, 2007. Of these patients, the hematoma was found by the initial head CT scan in 42 cases; 10 patients had delayed hematoma, and 6 showed delayed hematoma during craniotomy. All the patients were scanned using 16-slice spiral CT for coronal and sagittal three-dimensional reconstruction, and the total hematoma volume and the supratentorial and infratentorial hematoma volumes were calculated. Forty-two patients were found to have the straddling hematoma volume no less than 30 mL or infratentorial hematoma volume over 15 mL. According to the extension of the hemotoma, a bone flap spanning the transverse sinus was taken, and after hematoma removal, the bone flap was reduced and fixed with cranial screws. In 8 patients with other hematomas or severe intracranial hypertension, routine removal of the hematoma or decompressive craniectomy was performed. Results Fifty-four of the patients recovered, 3 were capable of independent living, and 1 sustained severe disabilities after the operations. No death occurred in these patients. Conclusion In patients with epidural hematoma straddling the transverse sinus, conservative treatment can be administered in cases with the straddling hematoma volume < 30 mL or infratentorial hematoma volume < 15 mL, otherwise timely surgical interventions should be performed. One-step preparation of the bone flap spanning the transverse sinus is safe but secure internal fixation is necessitated after reduction of the bone flap.