Laparoscopic radical anterograde modular pancreatosplenectomy for pancreatic tail cancer / 中华普通外科杂志

Objective:To evaluate the safety and feasibility of laparoscopic radical anterograde modular pancreatosplenectomy (Lap-RAMPS).Methods:From Jan 2014 to Dec 2020, the clinical data of 83 patients who underwent laparoscopic radical resection for pancreatic tail cancer in LiHuili Hospital of Ningbo Medical Center were retrospectively analyzed.Results:Eighty-three cases were divided into Lap-RAMPS group (44 cases) and laparoscopic conventional distal pancreatectomy and splenectomy(Lap-CDP) group (39 cases). There were no significant differences in the duration of surgery [(245.34±70.30) min vs. (239.87±68.10) min], intraoperative blood lose [(159.32±115.60) ml vs. (208.97±161.70) ml] and intraoperative transfusions (2 cases vs. 3 cases) between the two groups ( P>0.05). There were no statistical significance in both groups in postoperative pancreatic fistula, postoperative bleeding grade, postoperative gastric emptying delay, Clavien-Dindo complication and postoperative hospital stay ( P>0.05). There were statistically significant differences in the negative margin rate (93.2% vs. 76.9%),lymph node harvest(12.91±8.24 vs. 8.49±6.85) and median survival time (25.0 months vs. 15.0 months) between the two groups ( P<0.05). Conclusion:Lap-RAMPS for pancreatic tail cancer is safe and feasible, increasing the negative rate of pancreatic margins, improving the lymph node harvest, and prolonging patients' survival time.

Risk analysis of blood glucose variation in type 2 diabetic STEMI patients with different HbA 1c levels undergoing emergency PCI / 中国医师杂志

Objective:To investigate the impact of short-term variability in fasting blood glucose (FPG) on the recent major cardiovascular adverse events (MACE) in patients with ST segment elevation myocardial infarction (STEMI) with different levels of glycated hemoglobin (HbA 1c) . Methods:Retrospective analysis was made on the patients with type 2 diabetes mellitus who underwent emergency percutaneous coronary intervention (PCI) due to STEMI from January 2016 to March 2020 in Shenzhen Hospital, Fuwai Hospital, Chinese Academy of Medical Sciences. The patients were divided into HbA 1c compliant group (<6.5%) and non-compliant group (≥6.5%). The blood glucose variability indexes defined included FPG variability score (FPG-VS), variability index independent of FPG mean (VIM) and mean fast plasma glucose (FPG-M). The logistic regression model was used to evaluate the relationship between different HbA 1c levels, blood glucose variability risk indicators, and MACE. Results:A total of 612 patients were ultimately included in the analysis. The blood glucose variability indicators (FPG-VS, VIM) of the HbA 1c non-compliant group (302 cases) were higher than those of the compliant group (310 cases): [FPG-VS: (0.7±0.3) vs (0.4±0.4), P<0.001, VIM: (0.4±0.2) vs (0.3±0.2), P<0.001], while there was no statistically significant difference in FPG-M between the two groups [(7.9±3.2) vs (8.0±3.9), P=0.221]. In the HbA 1c non-compliant group, the correlation between FPG-VS, VIM, and FPG-M and the risk of MACE within 30 days was 0.89(95% CI: 0.69-1.15), 1.21(95% CI: 0.65-2.25), and 1.06(95% CI: 0.97-1.16), respectively (all P>0.05). In the HbA 1c compliant group, FPG-VS was associated with an increase in MACE risk within 30 days ( P=0.04): for each increase in FPG variation ≥1 mmol/L, after multiple factor adjustment, the risk of MACE increased by 8% within 30 days ( OR=1.08, 95% CI: 0.71-1.65); Compared with FPG-VS<20%, FPG-VS≥80% increased the risk of MACE within 30 days by 33% ( OR=1.33, 95% CI: 0.21-8.25, P<0.01), while the correlation between VIM and FPG-M and the risk of MACE within 30 days was 1.65(95% CI: 0.96-2.83) and 1.15(95% CI: 0.98-1.35), respectively (all P>0.05). Conclusions:High FPG-VS is associated with the recent MACE risk in STEMI patients who do not meet HbA 1c standards. After reaching HbA 1c standards, FPG-VS remains an independent MACE risk factor.

Anti-mGluR5 encephalitis with mental disorders as the initial symptom： a case report / 四川精神卫生

This article reported the clinical features of a rare patient with anti-metabotropic glutamate receptor 5 （mGluR5） encephalitis with mental disorders as the initial symptom， so as to provide references for clinical diagnosis and treatment. The patient was a 38-year-old male， developed pharyngeal pain as prodromal symptoms， and the main clinical manifestations included rapidly progressive memory loss， anxiety and depression， and psychomotor excitement symptoms including irritability and impulsive behaviors. The disease had a progressive deterioration. In the most severe state， the patient became unconscious in a shallow coma， with further cognitive decline， hallucinations and delusions， and lack of self-awareness. Both cerebrospinal fluid and serum anti-mGluR5 antibody were strongly positive （1∶100）. After two sessions of hormone shock therapy， the patient showed significantly improvement in consciousness， cognitive， emotional and psychiatric dimensions.

Relationship of in-hospital mortality and using intra-aortic balloon pump with extracorporeal cardiopulmonary resuscitation in patients with cardiac arrest: a secondary analysis based on literature data / 中华危重病急救医学

Objective:To assess the effect of intra-aortic balloon pump (IABP) on in-hospital mortality in patients with cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective study was performed on 696 patients with intra-hospital cardiac arrest undergoing ECPR from Samsung Medical Center in Korea between January 2004 and December 2013. According to whether IABP was used, the patients were divided into ECPR group and ECPR+IABP group. Cox regression and propensity score matching (PSM) were used to examine the correlation between IABP usage and in-hospital mortality, and standardized mean difference ( SMD) was used to check the degree of PSM. Survival analysis of in-hospital mortality was performed by the Kaplan-Meier method, and further analyzed by the Log-Rank test. Using the propensity score as weights, multiple regression model and inverse probability weighting (IPW) model were used for sensitivity analysis. In-hospital mortality, extracorporeal membrane oxygenation (ECMO) withdrawal success rate and neurological function prognosis were compared between the two groups. Results:A total of 199 patients with cardiac arrest undergoing ECPR were included, including 120 males and 79 females, and the average age was (60.0±16.8) years. Thirty-one patients (15.6%) were treated with ECPR and IABP, and 168 patients (84.4%) only received ECPR. The total hospitalized mortality was 68.8% (137/199). The 1 : 1 nearest neighbor matching algorithm was performed with the 0.2 caliper value. The following variables were selected to generate propensity scores, including age, gender, race, marital status, insurance, admission type, service unit, heart rate, mean arterial pressure, respiratory rate, pulse oxygen saturation, white blood cell count. After the propensity score matching, 24 pairs of patients were successfully matched, with the average age of (63.0±12.8) years, including 31 males and 17 females. The in-hospital mortality was 72.6% (122/168) and 48.4% (15/31) in the ECPR group and the ECPR+IABP group [hazard ratio ( HR) = 0.48, 95% confidence interval (95% CI) was 0.28-0.82, P = 0.007]. Multiple regression model, adjusted propensity score, PSM and IPW model showed that the in-hospital mortality in the ECPR+IABP group was significantly lower compared with the ECPR group ( HR = 0.44, 0.50, 0.16 and 0.49, respectively, 95% CI were 0.24-0.79, 0.28-0.91, 0.06-0.39 and 0.31-0.77, all P < 0.05). The combined application of IABP could improve the ECMO withdrawal success rate [odds ratio ( OR) = 8.95, 95% CI was 2.72-29.38, P < 0.001] and neurological prognosis ( OR = 4.06, 95% CI was 1.33-12.40, P = 0.014) in adult cardiac arrest patients. Conclusion:In patients with cardiac arrest using ECPR, the combination of IABP was independently associated with lower in-hospital mortality, higher ECMO withdrawal success rate and better neurological prognosis.

GnRH-a combined fertility-sparing re-treatment in women with endometrial carcinoma or atypical endomertial hyperplasia who failed to oral progestin therapy / 中华妇产科杂志

Objective:To analyze the clinical efficacy and pregnancy outcomes of gonadotropin-releasing hormone agonist (GnRH-a) based fertility-sparing re-treatment in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) who failed with oral progestin therapy.Methods:Forty cases with EC or AEH who failed to respond to oral progestin were included from January 2012 to December 2020 at Peking Union Medical College Hospital. Combination of GnRH-a with levonorgestrel-releasing intrauterine system (group GLI: a subcutaneous injection of GnRH-a every 4 weeks and LNG-IUS insertion constantly) or the combination of GnRH-a with aromatase inhibitor (group GAI: a subcutaneous injection of GnRH-a every 4 weeks and oral letrozole 2.5 mg, daily) were used for these patients. Histological evaluation were performed at the end of each course (every 3-4 months) by hysteroscopy and curettage. After the complete remission (CR), all patients were followed up regularly.Results:(1) Clinical characteristics:among the 40 patients with EC or AEH, the median age at diagnosis was 31 years (range: 22-40 years) and the median body mass index was 24.7 kg/m 2 (range: 18.9-39.5 kg/m 2). (2) Efficacy of fertility-sparing re-treatment: 37 (92%, 37/40) patients achieved CR, 6 (6/7) in AEH and 31 (94%, 31/33) in EC patients. The CR rate was 93% (26/28) and 11/12 in group GLI and GAI, respectively. The median time to CR was 5 months (range: 3-12 months). At the end of the first therapy course, the CR rates in AEH and EC were 5/7 and 42% (14/33), at the second course, the CR rates were 6/7 and 82% (27/33), respectively. (3) Recurrence: after 25 months of median follow-up duration (range: 10-75 months), 8 (22%, 8/37) women developed recurrence, 1/6 in AEH and 7 (23%, 7/31) in EC patients, with the median recurrence time of 18 months (range: 9-26 months). Among them, two cases who had completed childbirth chose to receive hysterectomy directly. Six patients met the criteria of fertility-preserving therapy and received conservative treatment again and 5 (5/6) of them achieved CR. (4) Pregnancy: of the 37 patients with CR, 33 desired to conceive. Ten women attempted to get pregnancy spontaneously and 23 cases with assisted reproductive technology. Fourteen (42%, 14/33) patients became pregnant, including 9 (27%, 9/33) live births, 3 (9%, 3/33) missed abortions, and 2 (6%, 2/33) miscarriages at the second trimester. Conclusions:GnRH-a based fertility-sparing re-treatment in AEH or EC patients who failed with oral progestin therapy achieved good treatment effect and reproductive outcomes. It is an encouraging alternative regime for patients who failed with oral progestin therapy.

Repair of dry eye-related corneal epithelial damage / 中华实验眼科杂志

Corneal epithelial injury refers to the destruction of corneal epithelial function and structural integrity caused by various reasons.Dry eye is a common cause of corneal epithelial damage and it also delays the healing of corneal epithelial wound.The change of tear film stability is a main mechanism of dry eye disease, which implies an important role of improving the tear film stability in dry eye and the repair of dry eye-related corneal epithelial damage.Ocular surface lubricants can be used to supplement the water-like liquid, mucin and lipid that tears naturally have.Anti-inflammatory drugs can improve the stability of tear film.When the ocular surface microenvironment is affected, the growth factors of the tear are unable to meet the needs of rapid repair of the damage.Therefore, it is necessary to supplement exogenous growth factor to promote injury healing of corneal epithelium.In this article, the repair of corneal epithelial damage associated with dry eye were reviewed, including the therapies of ocular surface lubricant, anti-inflammation and promoting repair of corneal epithelium.

Clinical study of Chaishao-Shugan-Lidan-Paishi Decoction assisted laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones / 国际中医中药杂志

Objective:To investigate the effect of Chaishao-Shugan-Lidan-Paishi Decoction assisted with laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones. Methods:According to the random number table method, 198 cases of chronic cholecystitis combined with cholecystolithiasis were admitted to our hospital from January 2016 to January 2019 and were divided into two groups, 99 cases in each group. Laparoscopic cholecystectomy was performed in both group. Then the control group was treated with Ursodeoxycholic Acid, and the observation group was treated with Chaishao-Shugan-Lidan-Paishi Decoction on the basis of the control group. Both groups were treated for 8 weeks. The clinical efficacy was evaluated after the treatment TCM symptoms and signs were scored before and after the treatment; the levels of TNF-α, IL-6, hs-CRP, gastrin (GAS), motilin (MOT) and somatostatin (SST) were detected by double antibody sandwich ELISA, and the adverse reactions during the treatment were recorded. Results:The total effective rate of the observation group was 94.9% (94/99), the control group was 82.8% (82/99), the difference between the two groups was statistically significant ( χ2=7.364, P=0.007). The score of the right flank pain, the level of upset and irritable condition, the sense of fullness of epigastric cavity, greasiness, nausea and vomiting, belching score after the treatment in the observation group were significantly lower than those in the control group ( t values were 7.229, 4.773, 4.442, 2.302, 5.887, 4.235, respectively, P<0.05 or P<0.01). After the treatment, the levels of serum TNF-α, IL-6, hs-CRP in the observation group were significantly lower than those in the control group ( t values were 9.330, 18.425, 26.886, respectively, all Ps<0.05), and the levels of serum GAS (104.53 ± 2.13 ng/L vs. 96.61 ± 3.29 ng/L, t=20.106) and MOT (386.60 ± 9.42 ng/L vs. 345.50 ± 12.80 ng/L, t=25.731) in the observation group were significantly higher than those of the control group, SST (40.05 ± 4.39 ng/L vs. 48.42 ± 5.11 ng/L, t=12.362) in the observation group was significantly lower than that of the control group ( P<0.01). No serious adverse reactions occurred during the treatment period in both groups. Conclusion:Chaishao-Shugan-Lidan-Paishi Decoction assisted laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones can improve the clinical symptoms, inhibit inflammation, improve gastrointestinal function, improve clinical efficacy.

Inhibitory effects of gomisin A combined with carboplatin on proliferation,invasion and metastasis of human ovarian cancer Skov3 cells and their mechanisms / 吉林大学学报(医学版)

Objective:To explore the inhibitory effects of gomisin A(GA)in combination with carboplatin (CBP)on the proliferation,invasion and metastasis of human ovarian cancer Skov3 cells and their mechanisms,and to illustrate the synergistic antitumor effect of GA.Methods:The ovarian cancer Skov3 cells were treated with different concentrations of GA combined with different concentrations of CBP.MTT assay was used to detect the inhibitory rates of proliferation.According to the results,the appropriate concentrations of GA and CBP were conformed.The Skov3 cells were treated with PBS,GA(0.04 μmol·L-1),CBP(16 mg·L-1)and GA (0.04 μmol·L-1)in combination with CBP(16 mg·L-1),respectively,and used as control group,GA group, CBP group and GA+CBP group.After 48 h of treatment,the cell morphology was observed by optical microscope, the cell reproductive ability was determined by clonogenic cell survival assay,and the cell migration ability was measured by cell wound healing test;Transwell experiment was used to detect the cell invasion ability.The expression levels of MMP-2 and MMP-9 mRNA were determined by RT-PCR and the protein expression levels of MMP-2,MMP-9,AKT1 and pAKT1 were determined by Western blotting method.Results:Compared with GA and CBP groups,the inhibitory rate of proliferation of Skov3 cells in GA + CBP group was significantly increased (P<0.01).The concentrations of GA and CBP for the best dose ratio were 0.04 μmol·L-1and 16 mg·L-1, respectively.The results of clone formation assay showed that the colony formation rates in CBP and GA+CBP groups were decreased compared with control group(P<0.05 or P<0.01);the colony formation rate of cells in GA + CBP group was significantly decreased compared with GA and CBP groups(P<0.01);the wound scratch assay results suggested that the number of metastic Skov3 cells in GA and CBP groups were decreased compared with control group;and the number of metastic Skov3 cells in GA+ CBP group was decreased compared with GA and CBP groups.The results of Transwell expriment showed that the capacities of cells passing the ECM in GA and CBP groups were decreased compared with control group;the capacity of cells passing the ECM was decreased compared with GA and CBP groups.The RT-PCR and Western blotting results showed that the expression levels of MMP-2 and MMP-9 mRNA in GA+CBP group were down-regulated compared with GA and CBP groups(P<0.01),and the expression levels of MMP-2,MMP-9,AKT1 and pAKT1 protein were down-regulated(P<0.01).Conclusion:GA can enhance the ability of CBP to inhibit the proliferation,invasion and metastasis of human ovarian cancer Skov3 cells,and thus play a role in decreasing the toxicity and increasing the efficacy of chemotherapy.

Enhancement of gomisin A in pro-apoptotic effect of carboplatin on human ovarian cancer Skov3 cells and its mechanism / 吉林大学学报(医学版)

Objective:To explore the effect of gomisin A (GA) in combination with carboplatin (CBP) on the apoptosis of ovarian cancer Skov3 cells,and to illustrate the synergistic antitumor effect of GA.Methods:The ovarian cancer Skov3 cells were treated with GA combined with CBP.MTT assay was used to detect the inhibitory rates of proliferation and the appropriate concentrations of GA and CBP were selected according to the results.The Skov3 cells were divided into control group,GA (0.04 μmol · L-1) group,CBP (16 mg · L 1) group and GA (0.04 μmol· L-1)+ CBP (16 mg · L-1) group.After 48 h treatment,the cell morphology was observed by microscope,the apoptotic rate was measured by flow eytometry,the apoptotic index (AI) was observed by TUNEL staining,the mitochondrial membrane potential was detected by JC-1 staining,and the mRNA and protein expression levels of apoptosis-related genes (Bax,caspase-3,Stat3) were determined by RT PCR and Western blotting method.Results:The inhibitory rate of proliferation of Skov3 cells in GA + CBP group (52.1％) was significantly higher than those in GA and CBP groups (P＜0.01).The concentrations of GA and CBP for the best dose ratio were 0.04 μmol· L-1 and 16 mg · L-1,respectively.Compared with control group,the cell refractivities were decreased,the cells retracted,and part of cells were suspended in GA group and CBP groups;there were more suspended cells and cell retraction phenomenon was more prominent in GA + CBP group.The results of TUNEL staining and flow cytometry showed that the AI and apoptotic rate of cells in GA + CBP group were significantly increased compared with control group,GA and CBP group (P＜0.05 or P＜0.01);the JC-1staining results suggested that the mitochondrial membrane potential of Skov3 cells in GA + CBP group was decreased (P＜0.05 or P＜0.01).The RT-PCR and Western blotting results showed that the expression levels of Bax and caspase-3 mRNA and protein were up-regulated (P＜0.05) and the expression levels of Bcl-2 and Stat3mRNA and protein in GA + CBP group were down-regulated compared with control,GA and CBP groups (P＜0.05).Conclusion:GA can enhance the ability of CBP to induce the apoptosis of human ovarian cancer Skov3 cells,and its mechanisms may be related to the up-regulation of the Bax and Caspase-3 expressions and the down-reguation of the Bcl-2 expression;GA can synergize the induction of CBP on apoptosis.

Research progress on plastic bronchitis / 中华实用儿科临床杂志

Plastic bronchitis is a rare,multisystem,clinical syndrome characterized by endobronchial,tubular,and localized or extensive obstruction resulting in acute fatal respiratory distress.The disease is more common in infectious diseases in China,but it is reported abroad after the operation of congenital heart disease.The treatment of plastic bronchitis is a challenging problem with a high mortality rate and no effective treatment has been introduced.The bronchoscope as an acute phase can only relieve symptoms of treatment recognized by domestic and foreign scholars,drug treatment is various,but there is no uniform standard,bronchodilators,hypertonic saline,leukotriene modifiers,macrolides,glucocorticoid,mucolytic agent,heparin,fibrinolytic agents,heart replacement and cardiopulmonary replacement therapy has been mentioned in clinical application.The pathogenesis of plastic bronchitis is not clear and the clinical manifestations are diverse.Early diagnosis and treatment are particularly important.

Effect of CPAP therapy on sleep quality and quality of life in patients with moderate or severe OSAHS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess the effect of CPAP therapy on sleep quality and quality of life in patients with moderate or severe OSAHS.@*METHOD@#Seventy-two patients diagnosed as OSAHS by polysomnography (PSG) were assigned to receive CPAP therapy for 3 months. At baseline and three months after treatment patients underwent polysomnography (PSG). Analyze the results of PSG, sleep quality, excessive daytime sleepiness, quality of life and the general well-being.@*RESULT@#The lowest average oxygen saturation and the average blood oxygen saturation improved significantly after CPAP therapy, and the longest sleep apnea time and AHI decreased obviously (P < 0.01). Except body pain, the other seven dimensions of SF-36 improved obviously (P < 0.01); ESS, PSQI and GWB also improved (P < 0.05).@*CONCLUSION@#For patients with moderate or severe OSAHS, CPAP therapy can obviously improve the sleep quality, excessive daytime sleepiness, improve patients' life quality and the general well-being.

Identification of the wild germplasm of Prunus mume based on AFLP markers / 生物工程学报

Mei (Prunus mume Sieb.et Zucc.) is traditionally not only a famous special ornamental plant but also a fruit tree origined in China. In order to conserve and ultilize scientifically the germplasm resources of wild mei, we identified and analysed the germplasm of mei flower in 65 samples collected from the habitat, using AFLP makers in combination with morphological anaylsis. This study amplified clearly 1 728 polymorphic bands, using the 8- pair-primer of Mse I -EcoR I screened totally from 64 -primer combination. According to the Nei' 72 distance coefficient clustering, all of the formas and varieties used in this study, including Prunus mume var. mume, P. mume, P. mume var. goethartiana, P. mume var. pallescens, P. mume var. microcarpa, P. mume var. cenrnus-sempervirens (newly recoeding variety), P. mume var. cernua, P. mume var. pallidus, P. mume var. taomei, were identified at the point of Nei' 72=0.26. Due to the genetic difference obviously among the formas and varieties, we suggested that wild germplasmtypes of all formas and varieties in P. mume should be conserved in their habitats in the furture.

Relationship between polymorphism in HO-1 gene promoter and susceptibility of coronary artery disease / 中国医师杂志

ObjectiveThis study is designed to investigate the relationship between STR polymorphism in HO-1 gene promoter and susceptibility of CAD,in order to provide a new strategy for prevention and treatment of CAD by using HO-1.Methods200 patients who were diagnosed as CAD by coronary angiography were selected in this study.100 subjects without evidence of CAD under coronary angiography with their sex and age similar to CAD patients were selected as controls.Genotyping was performed using polymerase chain reaction followed by capillary electrophoresis automated DNA sequencer.Each size of the (GT) n repeat was calculated using the GeneMapper Analysis software.ResultsA (GT)n polymorphism was found in the HO-1 gene promoter with n =16 ～39.Subjects with n≤29 expressed much more HO-1 protein than those with n ＞29( P ＜0.01 ).The alleles were then classified into two subgroups,S'allele (n 29 ) and L'allele (n ＞29),the subjects were then classified as having an S/S,S/L,or L/L genotype.Subjects with the L allele ( L/L + L/S genotypes) had more chance to get CAD than those with S/S genotype ( adjusted OR =1.83,95 ％ CI =1.04 - 3.24).Stratified analysis further showed that L allele ( L/L + L/S genotypes) was susceptive to CAD in patients who smoke (adjusted OR =2.59,95％ CI =1.16 -5.80).ConclusionsThe (GT)n polymorphism in HO-1 gene promoter is related to susceptibility to CAD,especially in those patients who smoke.