Vitamin D receptor (VDR) mediates the quiescence of activated hepatic stellate cells (aHSCs) by regulating M2 macrophage exosomal smooth muscle cell-associated protein 5 (SMAP-5) / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

An effective therapeutic regimen for hepatic fibrosis requires a deep understanding of the pathogenesis mechanism. Hepatic fibrosis is characterized by activated hepatic stellate cells (aHSCs) with an excessive production of extracellular matrix. Although promoted activation of HSCs by M2 macrophages has been demonstrated, the molecular mechanism involved remains ambiguous. Herein, we propose that the vitamin D receptor (VDR) involved in macrophage polarization may regulate the communication between macrophages and HSCs by changing the functions of exosomes. We confirm that activating the VDR can inhibit the effect of M2 macrophages on HSC activation. The exosomes derived from M2 macrophages can promote HSC activation, while stimulating VDR alters the protein profiles and reverses their roles in M2 macrophage exosomes. Smooth muscle cell-associated protein 5 (SMAP-5) was found to be the key effector protein in promoting HSC activation by regulating autophagy flux. Building on these results, we show that a combined treatment of a VDR agonist and a macrophage-targeted exosomal secretion inhibitor achieves an excellent anti-hepatic fibrosis effect. In this study, we aim to elucidate the association between VDR and macrophages in HSC activation. The results contribute to our understanding of the pathogenesis mechanism of hepatic fibrosis, and provide potential therapeutic targets for its treatment.

Landmark vessel in membrane anatomy-based colorectal surgery / 中华胃肠外科杂志

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.

Progress on the application of porcelain veneers in the restoration of dental fluorosis and its influencing factors / 中华地方病学杂志

Due to the cloud-like appearance of the dental surface of dental fluorosis, serious tooth defect may occur, thus affecting the overall beauty of the face. The clinical effect of dental fluorosis is not better than that of normal teeth in the application of repair, which brings some difficulties to the clinicians. The application of porcelain veneers in the restoration of dental fluorosis has been widely concerned by clinicians and researchers due to its advantages of high aesthetics, small amount of tooth tissue abrasion, and good biocompatibility. Therefore, this article comprehensively discusses the application effect and influencing factors of porcelain veneers in the restoration of dental fluorosis, in order to provide some reference for clinical application.

Effect of autologous platelet-rich plasma on postoperative bleeding and prognosis of patients undergoing heart valve surgery / 实用医学杂志

Objective To investigate the impact of autologous platelet-rich plasma on postoperative bleeding and patient prognosis in individuals undergoing heart valve surgery.Methods This study is a retrospective cohort study that included patients who underwent heart valve surgery at Xiamen Hospital,Zhongshan Hospital,Fudan University from September 2018 to January 2023.The patients were divided into two groups based on whether they underwent autologous platelet-rich plasma(aPRP)collection before surgery:Group A(no PRP collection)and Group B(PRP collection group).The main endpoint measure was the volume of pericardial mediastinal drainage on the day of surgery(D0),the first postoperative day(D1),and the second postoperative day(D2).The secondary endpoint indicators included postoperative mechanical ventilation time,duration of mediastinal drainage tube reten-tion,length of stay in the intensive care unit(ICU),postoperative hospitalization time,incidence of adverse events during postoperative hospitalization,and postoperative coagulation function.Propensity score matching was used to balance preoperative baseline characteristics,including gender,age,Body Mass Index(BMI),prothrombin time(PT),International Normalized Ratio(INR),platelet count(PLT),activated clotting time(ACT),ASA grade,NYHA grade,surgical name,surgical method,and preoperative comorbidities.Based on the matched data,the effect of PRP on postoperative bleeding and prognosis in patients following heart valve surgery was investi-gated.Results After propensity score matching,Group B patients showed a significant decrease in D2 drainage volume compared to Group A[(132.42±84.11)vs.(218.39±160.39),P = 0.01].Additionally,Group B had significantly shorter postoperative mechanical ventilation time[(1.88±0.99)vs.(2.7±2.47),P = 0.015],ICU stay time[(3.07±2.01)vs.(4.97±6.26),P = 0.006],and pericardial mediastinal drainage retention time[(5.72±1.85)vs.(9.23±5.05),P = 0.01].Moreover,the overall incidence of adverse events was reduced in Group B compared to Group A[5(8.3%)vs.14(23%),P = 0.024].At D0,D1,and D2,there was no statisti-cally significant difference in hospital stay or postoperative coagulation function between the two groups of patients.Conclusions PRP has been proven to minimize pericardial mediastinal drainage on the second postoperative day,as well as the duration of mechanical ventilation,ICU stay,retention of pericardial mediastinal drainage,and over-all incidence of postoperative adverse events.

Clinical value of helium-free magnetocardiography in diagnosis of coronary heart disease / 中华全科医师杂志

Objective:To assess the clinical value of helium-free magnetocardiography(MCG) in the diagnosis of coronary artery disease(CAD).Methods:A total of 213 patients with suspected CAD undergoing MCG in Beijing Anzhen Hospital were enrolled in the study. All patients underwent coronary CT angiography/invasive coronary angiography(CCTA/ICA) within 48 hours after MCG scanning. The parameters of MCG, including magnetic field multipolarization, magnetic field unipolarization, T-wave flattened, change in magnetic field distribution at TT segment, abnormal T-peak amplitude ration of maximum to minimum, significant movement of poles, magnetic field angle deviation and abnormal distribution of positive pole were used for the evaluation of the stenosis of coronary arteries.Results:Among 213 patients, MCG scanning was completed in 193 cases(90.6%), while 20 cases were excluded for various reasons. The CCTA/ICA results were taken as gold standard, the total coincidence rate of MCG with the degree of stenosis was 88.60%(95% CI: 83.25%-92.72%), the sensitivity and specificity of MCG in the diagnosis of CAD was 89.63%(95% CI: 83.21%-94.21%) and 88.23%(95% CI:78.12%-94.78%), respectively; the positive and negative predictive value were 93.80%(95% CI:88.72%-96.68%) and 81.08%(95% CI:72.15%-87.64%), respectively. Conclusion:MCG is highly accurate in the diagnosis of CAD, it may be widely used clinically as an non-invasive method free of radiation or contrast agent.

Research progress of proximity labeling technology based on biotin ligase in proteomics / 中国药科大学学报

@#Proximity-dependent biotinylation (PDB) uses biotin ligase fused to the protein of interest to biotinylate adjacent proteins, purify them with streptavidin beads, and then identify the biotinylated protein by mass spectrometry.This technology can be used to detect transient and/or low affinity interactions, provide a chance to learn more about membrane-less organelles and other subcellular structures that cannot be easily isolated or purified, and fill the gap in traditional methods.This article summarizes the technological development and application of PDB in recent years.

Clinical features and prognosis of childhood B-lineage acute lymphoblastic leukemia expressing the PRAME gene / 中国当代儿科杂志

OBJECTIVES@#To study the clinical and prognostic significance of the preferentially expressed antigen of melanoma (PRAME) gene in the absence of specific fusion gene expression in children with B-lineage acute lymphoblastic leukemia (B-ALL).@*METHODS@#A total of 167 children newly diagnosed with B-ALL were enrolled, among whom 70 were positive for the PRAME gene and 97 were negative. None of the children were positive for MLL-r, BCR/ABL, E2A/PBX1, or ETV6/RUNX1. The PRAME positive and negative groups were analyzed in terms of clinical features, prognosis, and related prognostic factors.@*RESULTS@#Compared with the PRAME negative group, the PRAME positive group had a significantly higher proportion of children with the liver extending >6 cm below the costal margin (P<0.05). There was a significant reduction in the PRAME copy number after induction chemotherapy (P<0.05). In the minimal residual disease (MRD) positive group after induction chemotherapy, the PRAME copy number was not correlated with the MRD level (P>0.05). In the MRD negative group, there was also no correlation between them (P>0.05). The PRAME positive group had a significantly higher 4-year event-free survival rate than the PRAME negative group (87.5%±4.6% vs 73.5%±4.6%, P<0.05), while there was no significant difference between the two groups in the 4-year overall survival rate (88.0%±4.4% vs 85.3%±3.8%, P>0.05). The Cox proportional-hazards regression model analysis showed that positive PRAME expression was a protective factor for event-free survival rate in children with B-ALL (P<0.05).@*CONCLUSIONS@#Although the PRAME gene cannot be monitored as MRD, overexpression of PRAME suggests a good prognosis in B-ALL.

Utility of GPR68 and TIL in TPF-induced chemotherapy and prognosis evaluation in middle-advanced hypopharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the roles of G Protein-Coupled Receptor 68 (GPR68) and tumor infiltrating lymphocytes (TIL) in TPF-(paclitaxel, cisplatin and 5-fluorouracil) induced chemotherapy for middle-advanced hypopharyngeal squamous cell carcinomas. Methods: A total of 31 patients with middle-advanced hypopharyngeal squamous cell carcinoma before TPF-inducted chemotherapy were enrolled from September 2012 to November 2017 in Beijing Tongren Hospital, Capital Medical University, including 28 males and 3 females, aged 43 to 71 years old. The expression of GPR68 and tumor infiltrating CD4+and CD8+T cells before chemotherapy was detected by immunohistochemical staining, and the relationships between GPR68 expression and clinical features, chemotherapy efficacy and overall survival (OS) were analyzed using t-test. Results: After 3 cycles of chemotherapy, there were 4, 14, 10 and 3 patients respectively with complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). The positive rates of GPR68 and CD8 were 25% and 40% respectively in the effective group (CR+PR), while 50% and 15% in the ineffective group (SD+PD), with statistically significant differences between two groups (t=5.17 and 12.86,P<0.001). Linear regression analysis showed that GPR68 was negatively correlated with CD8+T cells (r=-0.64,P<0.001). There was no significant correlation between the CD4 expression and TPF efficacy (P>0.05). The mean OS was 12.5 months in patients with high-expressed GPR68 and 25.0 months in patients with low-expressed GPR68, with a statistically significant difference (P=0.005). And mean OS was 25.0 months in patients with high-expressed CD8 and 14.5 months in low-expressed CD8, with a statistically significant difference (HR=2.58, P=0.019). Cox regression analysis showed that GPR68 and CD8+T cells were significant prognostic factors (OR(95%CI)=3.27(2.46-5.97) and 1.53(0.78-1.82), all P<0.05), while CD4 had no significant effect on prognosis (P>0.05). Conclusion: GPR68 and CD8+T cells are expected to be biomarkers for evaluating the efficacy and prognosis of TPF-induced chemotherapy in patients with middle-advanced hypopharyngeal squamous cell carcinoma.

Donor-specific antibodies, glomerulitis, and human leukocyte antigen B eplet mismatch are risk factors for peritubular capillary C4d deposition in renal allografts / 中华医学杂志(英文版)

BACKGROUND@#The complement system plays an important role in the immune response to transplantation, and the diagnostic significance of peritubular capillary (PTC) C4d deposition (C4d+) in grafts is controversial. The study aimed to fully investigate the risk factors for PTC C4d+ and analyze its significance in biopsy pathology of kidney transplantation.@*METHODS@#This retrospective study included 124 cases of kidney transplant with graft biopsy and donor-specific antibody (DSA) testing from January 2017 to December 2019 in a single center. The effects of recipient pathological indicators, eplet mismatch (MM), and DSAs on PTC C4d+ were examined using univariate and multivariate logistic regression analyses.@*RESULTS@#In total, 35/124 (28%) were PTC C4d+, including 21 with antibody-mediated rejection (AMR), eight with renal tubular injury, three with T cell-mediated rejection, one with glomerular disease, and two others. Univariate analysis revealed that DSAs (P < 0.001), glomerulitis (P < 0.001), peritubular capillaritis (P < 0.001), and human leukocyte antigen (HLA) B eplet MM (P = 0.010) were the influencing factors of PTC C4d+. According to multivariate analysis, DSAs (odds ratio [OR]: 9.608, 95% confidence interval [CI]: 2.742-33.668, P < 0.001), glomerulitis (OR: 3.581, 95%CI: 1.246-10.289, P = 0.018), and HLA B eplet MM (OR: 1.166, 95%CI: 1.005-1.353, P = 0.042) were the independent risk factors for PTC C4d+. In receiver operating characteristic curve analysis, the area under the curve was increased to 0.831 for predicting PTC C4d+ when considering glomerulitis, DSAs, and HLA B eplet MM. The proportions of HLA I DSAs and PTC C4d+ in active antibody-mediated rejection were 12/17 and 15/17, respectively; the proportions of HLA class II DSAs and PTC C4d+ in chronic AMR were 8/12 and 7/12, respectively. Furthermore, the higher the PTC C4d+ score was, the more serious the urinary occult blood and proteinuria of recipients at the time of biopsy.@*CONCLUSIONS@#PTC C4d+ was mainly observed in AMR cases. DSAs, glomerulitis, and HLA B eplet MM are the independent risk factors for PTC C4d+.

The correlation between serum heat shock protein 70, soluble programmed death protein 1, 25-hydroxy vitamin D 3 levels and prognosis in patients with hepatitis B associated liver cirrhosis combined with type 2 diabetes mellitus / 中国医师进修杂志

Objective:To investigate the expression of serum heat shock protein 70 (HSP70), soluble programmed death protein 1 (sPD-1), and 25-hydroxy vitamin D 3 in hepatitis B associated liver cirrhosis (HBLC) combined with type 2 diabetes mellitus (T2DM) and their value in prognostic prediction. Methods:The clinical data of 97 patients with HBLC combined with T2DM (HBLC combined with T2DM group), 105 patients with HBLC (HBLC group) and 118 patients with T2DM (T2DM group) from June 2018 to November 2019 in Zhejiang Putuo Hospital were prospectively analyzed. The serum levels of HSP70, sPD-1 and 25-hydroxy vitamin D 3 were compared among 3 groups, and the correlation between above serum indexes and liver function indexes, blood sugar indexes were analyzed. The liver function indexes included alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the blood sugar indexes included fasting blood glucose (FBG) and glycosylated hemoglobin (HbA 1c). According to the prognosis 6 months later, the patients with HBLC combined with T2DM were divided into poor prognosis (28 cases) and good prognosis (69 cases), and the HSP70, sPD-1, 25-hydroxy vitamin D 3 and liver function Child-Pugh classification were compared. The predictive value of serum HSP70, sPD-1 and 25-hydroxy vitamin D 3 on prognosis in patients with HBLC combined with T2DM was analyzed by receiver operating characteristic (ROC) curve. Results:The HSP70 and sPD-1 in HBLC combined with T2DM group were significantly higher than those in HBLC group and T2DM group: (4.28 ± 1.19) μg/L vs. (2.27 ± 0.76) and (2.40 ± 0.84) μg/L, (7.86 ± 2.45) ng/L vs. (4.23 ± 1.62) and (3.85 ± 1.27) ng/L, the 25-hydroxy vitamin D 3 was significantly lower than that in HBLC group and T2DM group: (13.62 ± 3.96) μg/L vs. (18.63 ± 6.11) and (17.45 ± 4.36) μg/L, and there were statistical differences ( P<0.05); there were no statistical differences between HBLC group and T2DM group ( P>0.05). The Pearson correlation analysis result showeds that HSP70 and sPD-1 were positively correlated with ALT, AST, FBG and HbA 1c ( P<0.01), the 25-hydroxy vitamin D 3 was negatively correlated with ALT, AST, FBG and HbA 1c ( P<0.01) in patients with HBLC combined with T2DM. In patients with HBLC combined with T2DM, the HSP70, sPD-1 and rate of Child-Pugh classification B in patients with poor prognosis were significantly higher than those in patients with good prognosis: (6.03 ± 1.63) μg/L vs. (3.57 ± 1.02) μg/L, (9.86 ± 1.59) ng/L vs. (7.05 ± 2.62) ng/L and 71.43% (20/28) vs. 30.43% (21/69), the 25-hydroxy vitamin D 3 was significantly lower than that in patients with good prognosis: (9.26 ± 3.02) μg/L vs. (15.39 ± 5.84) μg/L, and there were statistical differences ( P<0.01 or <0.05). The ROC curve analysis result showed that the area under curve of HSP70, sPD-1 combined with 25-hydroxy vitamin D 3 in predicting prognosis was the highest in patients with HBLC combined with T2DM, which was 0.890, with a sensitivity of 89.29% and a specificity of 79.71%. Conclusions:The levels of serum HSP70 and sPD-1 in patients with HBLC combined with T2DM increase, and the level of 25-hydroxy vitamin D 3 decreases. There is a good linear relationship with liver function and blood glucose. Early combined detection of the above serum levels can provide new ideas for clinical implementation of symptomatic treatment and prognosis prediction.

Role of the Anterior Cingulate Cortex in Translational Pain Research / 神经科学通报·英文版

As the most common symptomatic reason to seek medical consultation, pain is a complex experience that has been classified into different categories and stages. In pain processing, noxious stimuli may activate the anterior cingulate cortex (ACC). But the function of ACC in the different pain conditions is not well discussed. In this review, we elaborate the commonalities and differences from accumulated evidence by a variety of pain assays for physiological pain and pathological pain including inflammatory pain, neuropathic pain, and cancer pain in the ACC, and discuss the cellular receptors and signaling molecules from animal studies. We further summarize the ACC as a new central neuromodulation target for invasive and non-invasive stimulation techniques in clinical pain management. The comprehensive understanding of pain processing in the ACC may lead to bridging the gap in translational research between basic and clinical studies and to develop new therapies.

Simultaneous determination of rosuvastatin, atorvastatin and their metabolites in human plasma by UPLC-MS/MS / 国际药学研究杂志

Objective: To develop a ultra performance liquid chromatography- tandem mass spectrometry(UPLC- MS/MS) method for the simultaneous determination of rosuvastatin(RT), atorvastatin(AT)and their metabolites, i.e., atorvastatin lactone (ATL), ortho- hydroxy-atorvastatin(O-AT)and para-hydroxy-atorvastatin(P-AT), in human plasma. Methods: Deuterium-labeled compounds, RT-d6, AT-d5 and P-AT-d5 were used as the internal standards(IS). The plasma samples were extracted with ethyl acetate. The chromatographic separation was achieved on a ACQUITY UPLCTM BEH C18 column(50 mm×2.1 mm, 1.7 μm)with the mobile phase of 0.2%(v/v)formic acid aqueous solution and methanol by gradient elution. The flow rate was 0.2 ml/min, and the column temperature was 40℃. Analytes were detected on a tandem mass spectrometer, equipped with an electrospray ionization source that was operated in the positive mode. The selectivity, standard curve, precision and accuracy, extraction recoveries, matrix effect, and stability were investigated. Results: The linear range of RT was 0.1-50 ng/ml with r2 =0.9977. The linear range for AT, ATL, O-AT and P-AT was 0.05-50 ng/ml with r2 =0.9997, 0.9988, 0.9923 and 0.9995, respectively. Conclusion: The established method is rapid, sensitive, accurate, specific and reliable, which is suitable for the simultaneous determination of RT, AT and their metabolites in human plasma.

Clinical significance and influencing factors of linked color imaging technique in real-time diagnosis of active Helicobacter pylori infection / 中华医学杂志(英文版)

BACKGROUND@#Determining the Helicobacter pylori (H. pylori) infection state during the gastroscopic process is important but still challenging. The linked color imaging (LCI) technique might emphasize the mucosal color change after H. pylori infection, which might help the diagnosis. In the present study, we aimed to compare the LCI technique with traditional white light imaging (WLI) endoscopy for diagnosing active H. pylori infection.@*METHODS@#We collected and analyzed gastroscopic images from 103 patients in our hospital from November 2017 to March 2018, including both LCI and WLI modes. All images were randomly disordered and independently evaluated by four endoscopists who were blinded to the H. pylori status of patients. In addition, the H. pylori state was determined by both rapid urease test and pathology staining. The sensitivity, specificity, positive prediction value (PPV), and negative prediction value (NPV) were calculated for the detection of H. pylori infection. Moreover, the kappa value and interclass correlation coefficient (ICC) were used to evaluate the inter-observer variety by SPSS 24.0 software.@*RESULTS@#Of the 103 enrolled patients, 27 of them were positive for H. pylori infection, while the 76 patients were negative. In total, 388 endoscopic images were selected, including 197 WLI and 191 LCI. The accuracy rate for H. pylori evaluation in the corpus LCI group was significantly higher than other groups (81.2% vs. 64.3%-76.5%, χ = 34.852, P < 0.001). Moreover, the corpus LCI group had the optimal diagnostic power with the sensitivity of 85.41% (95% confidence interval [CI]: 76.40%-91.51%), the specificity of 79.71% (95% CI: 74.38%-84.19%), the PPV of 59.42% (95% CI: 50.72%-67.59%), and the NPV of 94.02% (95% CI: 89.95%-96.56%), respectively. The kappa values between different endoscopists were higher with LCI than with WLI (0.433-0.554 vs. 0.331-0.554). Consistently, the ICC value was also higher with LCI than with WLI (0.501 [95% CI: 0.429-0.574] vs. 0.397 [95% CI: 0.323-0.474]). We further analyzed the factors that might lead to misjudgment, revealing that active inflammation might disturb WLI judgment (accuracy rate: 58.70% vs. 76.16%, χ = 21.373, P < 0.001). Atrophy and intestinal metaplasia might affect the accuracy of the LCI results (accuracy rate: 66.96% vs. 73.47%, χ = 2.027; 68.42% vs. 73.53%, χ = 1.594, respectively); however, without statistical significance (P = 0.154 and 0.207, respectively).@*CONCLUSIONS@#The application of LCI at the corpus to identify H. pylori infection is reliable and superior to WLI. The inter-observer variability is lower with LCI than with WLI.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry: ChiCTR1800016730; http://www.chictr.org.cn/showproj.aspx?proj=28400.

Clinical significance and influencing factors of linked color imaging technique in real-time diagnosis of active Helicobacter pylori infection / 中华医学杂志(英文版)

Background@#Determining the Helicobacter pylori (H. pylori) infection state during the gastroscopic process is important but still challenging. The linked color imaging (LCI) technique might emphasize the mucosal color change after H. pylori infection, which might help the diagnosis. In the present study, we aimed to compare the LCI technique with traditional white light imaging (WLI) endoscopy for diagnosing active H. pylori infection.@*Methods@#We collected and analyzed gastroscopic images from 103 patients in our hospital from November 2017 to March 2018, including both LCI and WLI modes. All images were randomly disordered and independently evaluated by four endoscopists who were blinded to the H. pylori status of patients. In addition, the H. pylori state was determined by both rapid urease test and pathology staining. The sensitivity, specificity, positive prediction value (PPV), and negative prediction value (NPV) were calculated for the detection of H. pylori infection. Moreover, the kappa value and interclass correlation coefficient (ICC) were used to evaluate the inter-observer variety by SPSS 24.0 software.@*Results@#Of the 103 enrolled patients, 27 of them were positive for H. pylori infection, while the 76 patients were negative. In total, 388 endoscopic images were selected, including 197 WLI and 191 LCI. The accuracy rate for H. pylori evaluation in the corpus LCI group was significantly higher than other groups (81.2% vs. 64.3%-76.5%, χ2 = 34.852, P < 0.001). Moreover, the corpus LCI group had the optimal diagnostic power with the sensitivity of 85.41% (95% confidence interval [CI]: 76.40%-91.51%), the specificity of 79.71% (95% CI: 74.38%-84.19%), the PPV of 59.42% (95% CI: 50.72%-67.59%), and the NPV of 94.02% (95% CI: 89.95%-96.56%), respectively. The kappa values between different endoscopists were higher with LCI than with WLI (0.433-0.554 vs. 0.331-0.554). Consistently, the ICC value was also higher with LCI than with WLI (0.501 [95% CI: 0.429-0.574] vs. 0.397 [95% CI: 0.323-0.474]). We further analyzed the factors that might lead to misjudgment, revealing that active inflammation might disturb WLI judgment (accuracy rate: 58.70% vs. 76.16%, χ2 = 21.373, P < 0.001). Atrophy and intestinal metaplasia might affect the accuracy of the LCI results (accuracy rate: 66.96% vs. 73.47%, χ2 = 2.027; 68.42% vs. 73.53 %, χ2 = 1.594, respectively); however, without statistical significance (P = 0.154 and 0.207, respectively).@*Conclusions@#The application of LCI at the corpus to identify H. pylori infection is reliable and superior to WLI. The inter-observer variability is lower with LCI than with WLI.@*Trial registration@#Chinese Clinical Trial Registry: ChiCTR1800016730; http://www.chictr.org.cn/showproj.aspx?proj=28400

Methylation mechanism of candidate biomarker transcription factor 21 in bladder urothelial carcinoma / 解剖学报

Objective To explore the significance of methylation of the candidate biomarker transcription factor 21(TCF21) in bladder urothelial carcinoma. Methods From October 2016 to October 2017, 142 patients with suspected bladder cancer were selected. Among them, 80 were diagnosed as bladder cancer by pathological examination as the study group. A total of 62 non-bladder cancers were diagnosed by pathological examination as the control group. In addition, 40 healthy urine specimens during the same period were selected as the healthy group. Detected and compared the methylation of TCF21 in bladder cancer tissues, paracancerous tissues, and control tissues of the study group, and detected and compared the TCF21 methylation levels in urine of study group, control group, and healthy group. The relationship between TCF21 methylation level and clinicopathological features was explored, and the diagnostic efficacy of both for bladder cancer was analyzed. Results The methylation level of TCF21 in bladder cancer tissue was significantly higher than that in the adjacent tissue and control group (P 60 years, high TNM stages, and high grade bladder cancer patients (P 0. 05). Conclusion TCF21 gene hasd high methylation level in urine of patients with bladder cancer and bladder cancer, and is associated with pathological features. Urinary bladder cancer tissues and urine have higher diagnostic efficacy for bladder cancer.

Early Immunosuppressive Exposure of Enteric-Coated-Mycophenolate Sodium Plus Tacrolimus Associated with Acute Rejection in Expanded Criteria Donor Kidney Transplantation / 中华医学杂志(英文版)

<p><b>Background</b>Immunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection (BPAR) after expanded criteria donor (ECD) kidney transplantation. The aim of this study was to investigate the relationships between early immunosuppressive exposure and the development of BPAR.</p><p><b>Methods</b>We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolimus (Tac), and prednisone. The levels of mycophenolic acid-area under the curve (MPA-AUC) and Tac Cwere measured at the 1 week and the 1 month posttransplant, respectively. The correlation was assessed by multivariate logistic regression.</p><p><b>Results</b>The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC at the 1 week posttransplant was found in BPAR recipients (38.42 ± 8.37 vs. 50.64 ± 13.22, P < 0.01). In addition, the incidence of BPAR was significantly high (P < 0.05) when the MPA-AUClevel was <30 mg·h·L at the 1 week (15.0% vs. 44.4%) or the Tac Cwas <4 ng/ml at the 1 month posttransplant (33.3% vs. 21.6%). Multivariable logistic regression analysis showed that the MPA-AUC at the 1 week (OR: 0.842, 95% CI: 0.784-0.903) and the Tac Cat the 1 month (OR: 0.904, 95% CI: 0.822-0.986) had significant inverse correlation with BPAR (P < 0.05).</p><p><b>Conclusions</b>Low-level exposure of MPA and Tac Cin the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC <30 mg·h·L and Tac C <4 ng/ml should be avoided in the first few weeks after transplantation.</p>

Genotype, environment and their interactions of functional components in Rheum tanguticum / 中国中药杂志

Six kinds of provenance of Rheum tanguticum collected from Qinghai province as the test materials, which were transplanted under 3 different environments by using complete randomized block design with three replicates. The contents of the chemical components was determined by HPLC. This study aimed at analyzing the effect of genotype, environment and their interactions on the 4 kinds of functional components (phenolic acids, bianthrone, free anthraquinones and combined anthraquinones) in 14 kinds of active components of Rh. tanguticum, in order to provide a theoretical basis for the selection of cultivated Rh. tanguticum in high quality producing area and excellent provenance. The provenance trial showed that the genotype and environment influence on the effect of all kinds of functional components in Rh. tanguticum were significant (<0.05). The content of phenolic acids was mainly influenced by environment, and the other three kinds of functional components were affected by environment and their interactions. The proportion of environment was larger. The cultivation quality of Rh. tanguticum should give priority to environment, then choose a provenance. Sichuan may be beneficial in accumulation of combined anthraquinones in Rh. tanguticum, Gansu may facilitate the binding of free anthraquinone, phenolic acids and bianthrone content. Preliminary inference based on the content and proportion of efficacy components, T4 could be potential special medicinal germplasm that have function of heat-clearing and detoxifying drugs and activate blood circulation to dissipate blood stasis; T3 and T6 could all be potential specialmedicinal germplasms that exist diarrhea attack characters. The results of this study have certain guiding significance for the production of rhubarb precision medicinal materials.

Beneficial Effect of Moderately Increasing Hypothermic Machine Perfusion Pressure on Donor after Cardiac Death Renal Transplantation / 中华医学杂志(英文版)

Background@#Vascular resistance and flow rate during hypothermic machine perfusion (HMP) of kidneys is correlated with graft function. We aimed to determine the effects of increasing HMP pressure versus maintaining the initial pressure on kidney transplantation outcomes.@*Methods@#We retrospectively reviewed the data of 76 primary transplantation patients who received HMP-preserved kidneys from 48 donors after cardiac death between September 1, 2013, and August 31, 2015. HMP pressure was increased from 30 to 40 mmHg (1 mmHg = 0.133 kPa) in kidneys with poor flow and/or vascular resistance (increased pressure [IP] group; 36 patients); otherwise, the initial pressure was maintained (constant pressure group; 40 patients). Finally, the clinical characteristics and transplantation outcomes in both groups were assessed.@*Results@#Delayed graft function (DGF) incidence, 1-year allograft, patient survival, kidney function recovery time, and serum creatinine level on day 30 were similar in both groups, with improved flow and resistance in the IP group. Among patients with DGF, kidney function recovery time and DGF duration were ameliorated in the IP group. Multivariate logistic regression analysis revealed that donor hypertension (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.02-2.06, P = 0.035), donor terminal serum creatinine (OR: 1.27, 95% CI: 1.06-1.62, P = 0.023), warm ischemic time (OR: 3.45, 95% CI: 1.97-6.37, P = 0.002), and terminal resistance (OR: 3.12, 95% CI: 1.76-6.09, P = 0.012) were independent predictors of DGF. Cox proportional hazards analysis showed that terminal resistance (hazard ratio: 2.06, 95% CI: 1.32-5.16, P = 0.032) significantly affected graft survival.@*Conclusion@#Increased HMP pressure improves graft perfusion but does not affect DGF incidence or 1-year graft survival.

Predictive Score Model for Delayed Graft Function Based on Hypothermic Machine Perfusion Variables in Kidney Transplantation / 中华医学杂志(英文版)

Background@#Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial. Therefore, we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment.@*Methods@#From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios (ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model.@*Results@#HMP duration (OR = 1.165, 95% confidence interval [CI]: 1.008-1.360, P = 0.043), resistance (OR = 2.190, 95% CI: 1.032-10.20, P < 0.001), and flow rate (OR = 0.931, 95% CI: 0.894-0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories (scores 0-3, 4-7, 8-11, and 12-14) according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c-statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow (P = 0.012) and resistance (P = 0.006).@*Conclusion@#The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially useful for physicians in making optimal decisions about the organs donated.

Clinical analysis of total laparoscopic resection for colorectal cancer by NOSES: a report of 50 cases / 中国内镜杂志

Objective?To investigate the feasibility, safety, operating essentials and the short-term therapeutic effect of total laparoscopic resection for colorectal cancer by Natural Orifice Specimen Extraction (NOSES).?Methods?The clinical data of 50 patients underwent total laparoscopic resection for colorectal cancer by NOSES from January 2016 to June 2017 were retrospectively analyzed.?Results?All of the 50 patients with colorectal cancer successfully received total laparoscopic resection by NOSES. None of the patients had serious postoperative complications and death related to the operation. The average operating time was (140.0 ± 29.0) minutes. The blood loss was (70.0 ± 23.4) ml. The number of lymph nodes harvested were (14.0 ± 2.3). There was no bacteria infection in abdominopelvic cavity post-operation and no recurrence occurred until the end of postoperative follow- up. Postoperative time of bed rest was (2.0 ± 0.5) days. The time of the first anal exhaust was (2.0 ± 0.5) days. The postoperative hospitalization stay was (8.5 ± 3.0) days. There was none case of lung infection while one case of anastomotic leakage. No cancer cells remained in resection margin. No local recurrence and metastasis was found in all patients after follow-up for 3 to 24 months.?Conclusion?Total laparoscopic resection for colorectal cancer by NOSES is safe and feasible, and has the advantage of minimally invasive, less pain, rapid rehabilitation, good cosmetic effect and less postoperative complications.