Clinical efficacy of pancreaticoduodenectomy for periampullary diseases: a report of 2 019 cases / 中华消化外科杂志

Objective:To investigate the clinical efficacy of pancreaticoduodenectomy (PD) for periampullary diseases.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 2 019 patients with periampullary diseases who underwent PD in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 1 193 males and 826 females, aged 63(15) years. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) postoperative pathological examinations; (4) prognosis of patients with periampullary carcinoma. Regular follow-up was conducted by telephone interview and outpatient examination once every 3 months within the postoperative first year and once every 6 months thereafter to detect the survival of patients with periampullary carcinoma. The follow-up was up to December 2021. Measurement data with skewed distribution were represented as M(IQR) or M(range), and comparison between groups was analyzed using the rank sum test. Count data were described as absolute numbers and (or) percentages, and comparison between groups was analyzed by the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. Results:(1) Surgical situations: of 2 019 patients, 1 116 cases were admitted from 2016-2018 and 903 cases were admitted from 2019-2020. There were 1 866 cases undergoing open PD and 153 cases undergoing laparoscopic or robot-assisted PD. There were 1 049 cases under-going standard PD and 970 cases undergoing pylorus-preserved PD. There were 215 cases combined with portal mesenteric vein resection, 3 cases combined with arterial resection. The operation time of 2 019 patients was 255(104)minutes and the volume of intraoperative blood loss was 250(200)mL. The intraoperative blood transfusion rate was 31.401%(623/1 984), with the blood transfusion data of 35 cases missing. The proportions of pylorus-preservation, combination with portal mesenteric vein resection, intraoperative blood transfusion were 585 cases(52.419%), 97cases(8.692%), 384 cases(34.941%) for patients admitted in 2016-2018, versus 385 cases(42.636%), 118 cases(13.068%), 239 cases(27.006%) for patients admitted in 2019-2020, showing significant differences between them ( χ2=19.14,10.05,14.33, P<0.05). (2) Postoperative conditions: the duration of postoperative hospital stay of 2 019 patients was 13 (10) days. One of 2 019 patients lacked the data of postopera-tive complications. The overall postoperative complication rate was 45.292%(914/2 018), of which the incidence rate of grade B or C pancreatic fistula was 23.439%(473/2 018), the rate of grade B or C hemorrhage was 8.127%(164/2 018), the rate of grade B or C delayed gastric emptying was 15.312%(309/2 018), the rate of biliary fistula was 2.428%(49/2 018) and the rate of abdominal infection was 12.884%(260/2 018). The reoperation rate of 2 019 patients was 1.932%(39/2 019), the in-hospital mortality was 0.644%(13/2 019), the postoperative 30-day mortality was 1.238%(25/2 019), and the postoperative 90-day mortality was 2.675%(54/2 019). There were 541 cases(48.477%) with overall postoperative complications, 109 cases(9.767%) with grade B or C hemorr-hage, 208 cases(18.638%) with grade B or C delayed gastric emptying , 172 cases(15.412%) with abdominal infection, 39 cases(3.495%) with postoperative 90-day mortality of 1 116 patients admitted in 2016-2018. The above indicators were 373 cases(41.353%), 55 cases(6.098%), 101 cases(11.197%), 88 cases(9.756%), 15 cases(1.661%) of 902 patients admitted in 2019-2020, respectively. There were significant differences in the above indicators between them( χ2=10.22, 9.00, 21.30, 14.22, 6.45 , P<0.05). The in-hospital mortality occurred to 11 patients(0.986%) of 1 116 patients admitted in 2016-2018 and to 2 cases(0.221%) of 903 patients admitted in 2019-2020, showing a significant difference between them ( P<0.05). (3) Postoperative pathological examinations. Disease area of 2 019 patients reported in postoperative pathological examinations: there were 1 346 cases(66.667%) with lesions in pancreas, including 1 023 cases of carcinoma (76.003%) and 323 cases(23.997%) of benign diseases or low potential malignancy. There were 250 cases(12.382%) with lesions in duodenal papilla, including 225 cases of carcinoma (90.000%) and 25 cases(10.000%) of benign diseases or low potential malignancy. There were 174 cases(8.618%) with lesions in bile duct, including 156 cases of carcinoma (89.655%) and 18 cases(10.345%) of benign diseases or low potential malignancy. There were 140 cases(6.934%) with lesions in ampulla, including 134 cases of carcinoma (95.714%) and 6 cases(4.286%) of benign diseases or low potential malignancy. There were 91 cases(4.507%) with lesions in duodenum, including 52 cases of carcinoma (57.143%) and 39 cases(42.857%) of benign diseases or low potential malignancy. There were 18 cases(0.892%) with carcinoma in other sites. Postoperative pathological examination showed carcinoma in 1 608 cases(79.643%), benign diseases or low potential malignancy in 411 cases(20.357%). The histological types of 1 608 patients with carcinoma included adenocarcinoma in 1 447 cases (89.988%), intra-ductal papillary mucinous carcinoma in 37 cases(2.301%), adenosquamous carcinoma in 35 cases(2.177%), adenocarcinoma with other cancerous components in 29 cases(1.803%), neuroendocrine carcinoma in 18 cases(1.119%), squamous carcinoma in 1 case (0.062%), and other histological malignancies in 41 cases(2.550%). The histological types of 411 patients with benign or low poten-tial malignancy included intraductal papillary mucinous neoplasm in 107 cases (26.034%), chronic or autoimmune inflammatory disease in 62 cases(15.085%), neuroendocrine tumor in 58 cases(14.112%), pancreatic serous cystadenoma in 52 cases(12.652%), pancreatic solid pseudopapillary tumor in 36 cases(8.759%), gastrointestinal stromal tumor in 29 cases(7.056%), villous ductal adenoma in 20 cases(4.866%), pancreatic mucinous cystadenoma in 2 cases(0.487%), pancreatic or duodenal trauma in 2 cases(0.487%) and other histological types in 43 cases(10.462%). (4) Prognosis of patients with periampullary carcinoma. Results of survival analysis of 1 590 patients with main locations of periampullary carcinoma showed that of 1 023 patients with pancreatic cancer, 969 cases were followed up for 3.0-69.6 months, with a median follow-up time of 30.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates of pancreatic cancer patients were 19.5 months [95% confidence interval ( CI) as 18.0-21.2 months], 74.28%, 29.22% and 17.92%. Of 225 patients with duodenal papillary cancer, 185 cases were followed up for 3.0-68.9 months, with a median follow-up time of 36.7 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were unreached, 94.92%, 78.87% and 66.94%. Of 156 patients with distal bile duct cancer, 110 cases were followed up for 3.0-69.5 months, with a median follow-up time of 25.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 50.6 months (95% CI as 31.4 to not reached), 90.37%, 56.11% and 48.84%. Of 134 patients with ampullary cancer, 100 cases were followed up for 3.0-67.8 months, with a median follow-up time of 28.1 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 62.4 months (95% CI as 37.8 months to not reached), 90.57%, 64.98% and 62.22%. Of 52 patients with duodenal cancer, 38 cases were followed up for 3.0-69.5 months, with a median follow-up time of 26.2 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 52.0 months (95% CI as 30.6 months to not reached), 93.75%, 62.24% and 40.01%.There was a significant difference in overall survival after PD between patients with different locations of periampullary malignancies ( χ2=163.76, P<0.05). Conclusions:PD is safe and feasible in a high-volume pancreas center, but the incidence of overall postoperative complications remains high. With the increase of PD volume, the incidence of overall postoperative complications has significantly decreased. There is a significant difference in overall survival time after PD among patients with different locations of periampullary malignancies. The 5-year survival rate after PD for duodenal papillary cancer, ampullary cancer, duodenal cancer and distal bile duct cancer is relatively high, whereas for pancreatic cancer is low.

Application of veress needle combined with semi-rigid biopsy forceps in laparoscopic surgery of indirect inguinal hernia in children / 中国医师杂志

Objective:To explore the clinical effect of laparoscopic high ligation of inguinal hernia sac in children with veress needle and semi-rigid biopsy forceps.Methods:121 cases of indirect hernia of groin admitted in Rugao People's Hospital from June 2018 to November 2019 were analyzed retrospectively. According to the operation methods, 121 cases were divided into laparoscopic group ( n=76, laparoscopic high ligation of hernia sac with pneumoperitoneum needle and semi rigid biopsy forceps) and traditional operation group ( n=45, high ligation of traditional inguinal incision hernia sac). The operation time, intraoperative blood loss, incision length, postoperative self activity time and postoperative hospital stay were compared between the two groups; the patients were followed up for 3-21 months, and the proportion of postoperative complications and recurrence cases were compared between the two groups. Results:There was no significant difference in operative time between the two groups ( P=0.335), but the amount of bleeding [(3.8±0.7)ml vs (7.3±1.7)ml, P<0.05], the length of incision [(0.6±0.1)cm vs (1.8±1.2)cm, P<0.05], the time of recovery of self activity [(9.2±2.6)h vs (16.2±4.2)h, P<0.05] and the time of hospitalization [(1.3±0.6)d vs (3.4±1.3)d, P<0.05] in the laparoscopic group were all better than those in the traditional operation group; the proportion of complications and recurrence in the laparoscopic group during the follow-up period was less than that in the traditional operation group (χ 2=5.243, P=0.022). Conclusions:Laparoscopic high ligation of indirect hernia sac in children with veress needle and semi-rigid biopsy forceps has the advantages of small trauma, fast recovery and less postoperative complications, and the equipment is easy to obtain, which is convenient to carry out and promote in basic hospitals.

Application value of TRIANGLE operation in radical resection of pancreatic cancer / 中华消化外科杂志

Objective:To investigate the application value of TRIANGLE operation in radical resection of pancreatic cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 30 patients with pancreatic cancer who underwent TRIANGLE operation in the First Affiliated Hospital of Nanjing Medical University from March 2020 to July 2020 were collected. There were 18 females and 12 males, aged from 41 to 79 years, with a median age of 65 years. After assessment of the resectability and dissection of the hepatoduodenal ligament, the superior mesenteric artery, celiac axis, common hepatic artery, portal vein and superior mesenteric vein of patients were exposed. According to the location of tumor, patients were performed pancreaticoduodenectomy, distal pancreatectomy or total pancreatectomy combined with dissection of putatively tumor-infiltrated lymphatic and neural tissue from the triangular space. During the TRIANGLE operation, it required to at least finish the skeletonization of right semi-circumference of the superior mesenteric artery and celiac axis in cases of pancreatico-duodenectomy, whereas the left semi-circumference in cases of distal pancreatectomy. In principle, both of the superior mesenteric artery and celiac axis were circumferentially skeletonized for cases of total pancreatectomy. Lymphatic, neural and fibrous tissues between the superior mesenteric artery and the celiac artery were completely dissected in all patients. Observation indicators: (1) surgical conditions and postoperative histopathological examination; (2) postoperative recovery situations; (3) follow-up. Regular follow-up was conducted by telephone interview or outpatient examinations to understand tumor recurrence and metastasis of patients up to January 2021. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, Fisher exact probability method was used for comparison between groups. Results:(1) Surgical conditions and postoperative histopathological examination: all patients underwent open operation, including 21 cases of pancreaticoduodenec-tomy, 6 cases of distal pancreatectomy, 2 cases of total pancreatectomy, 1 case of mid-segment preserving pancreatectomy. There were 16 cases combined with portal vein-superior mesenteric vein resection and 3 cases combined with left adrenal resection. For the dissection area of superior mesenteric artery-celiac axis, one cycle was conducted in 5 of 30 patients, one and a quarter cycle in 8 patients, one and a half cycle in 8 patients, one and three quarters?two cycles in 9 patients. There were 16 cases with left gastric vein dissection and 14 cases with left gastric vein preservation. The operative time of 30 patients was 287 minutes (range, 165?495 minutes) and the volume of intraoperative blood loss was 275 mL(range, 50?800 mL). Nine patients received intraoperative transfusion of red blood cells or frozen plasma. Postoperative histopathological examination showed that the tumor diameter was 3.4 cm (range, 1.2?7.3 cm), the number of harvested lymph nodes was 20 (range, 9?35), the number of positive lymph nodes was 2 (0?19). Of the 30 patients,20 cases had moderately differentiated tumor and 10 cases had poorly differentiated tumor. R 0 resection was achieved in 9 patients, 1 mm R 1 resection in 17 patients, and R 1 resection in 4 patients. Postoperative pathological T stages: 3 of 30 patents were in stage T1, 18 cases were in stage T2, 5 cases were in stage T3, and 4 cases were in stage T4. Postoperative pathological N stages: 9 of 30 patents were in stage N0, 13 cases were in stage N1, and 8 cases were in stage N2. Postoperative pathological TNM stages: 2 of 30 patents were in stage Ⅰa, 2 cases were in stage Ⅰb, 3 case were in stage Ⅱa, 11 cases were in stage Ⅱb, 12 cases were in stage Ⅲ. (2) Postoperative recovery situations: 20 of 30 patients had postoperative complications, including 6 cases of Clavien-Dindo grade I complications, 9 cases of grade Ⅱ complications, 3 cases of grade Ⅲa complications, 2 cases of grade V complications. The incidence of postoperative diarrhea was 0 in cases with one cycle dissection of tissues around superior mesenteric artery-celiac axis, 1/8 in cases with one and a quarter cycle dissection, 4/8 in cases with one and a half cycle dissection, 9/9 in cases in with one and three quarters-two cycles dissection, showing a significant difference between the four groups ( P<0.05). The incidence of delayed gastric emptying was 5/16 in patients with left gastric vein dissection, versus 1/14 in patients with left gastric vein preservation, showing no significant difference between the two groups ( P>0.05). Nineteen of 30 patients received adjuvant chemotherapy.Twenty-eight of 30 patients were successfully discharged from hospital, with the duration of postoperative hospital stay of 15 days(range, 8?68 days) and the rest of 2 patients died. Three patients had unplanned readmission within postoperative 90 days. (3) Follow-up: all the 28 patients discharged from hospital were followed up for 1.0?9.0 months, with the median follow-up time of 6.5 months. During the follow-up, one patient with locally advanced pancreatic cancer had local recurrence, 9 patients had liver metastasis (including 4 cases with resectable pancreatic cancer, 4 cases with borderline resectable pancreatic cancer, 1 case with borderline resectable pancreatic cancer), and 1 patient with borderline resectable pancreatic cancer had peritoneal metastasis. The rest of 17 patients survived without tumor recurrence. Conclusions:TRIANGLE operation in the radical resection of pancreatic cancer has high radicality and low postoperative local recurrence, but a slightly high morbidity and mortality rate. Its long-term efficacy needs to be further evaluated. It is recommend that this procedure should be performed for selected patients after neoadjuvant chemotherapy in high-volume pancreatic surgery centers.

Targeting redox-altered plasticity to reactivate synaptic function: A novel therapeutic strategy for cognitive disorder

Redox-altered plasticity refers to redox-dependent reversible changes in synaptic plasticity

Fertility-preserving treatment outcome in endometrial cancer or atypical hyperplasia patients with polycystic ovary syndrome / 부인종양

Objective@#This study aimed to investigate the impact of polycystic ovary syndrome (PCOS) on fertility-sparing treatment in young patients with atypical endometrial hyperplasia (AEH) or endometrioid endometrial cancer (EEC). @*Methods@#A total of 285 patients with EEC (n=76, FIGO stage IA, without myometrium invasion) or AEH (n=209) who received progestin-based fertility-sparing treatment were evaluated retrospectively. Among the 285 patients, 103 (36.1%), including 70 AEH cases and 33 EEC cases, were diagnosed with PCOS. General characteristics, cumulative 16- and 32-week complete response (CR) rate, pregnancy outcome and recurrence were compared between patients with or without PCOS. @*Results@#The cumulative 16-week CR rate was lower in the PCOS group than in the non-PCOS group (18.4% vs. 33.8%, p=0.006). Patients with PCOS took longer treatment duration to achieve CR (7.0 months vs. 5.4 months, p=0.006) and shorter time to relapse after CR (9.6 months vs. 17.6 months, p=0.040) compared with non-PCOS group. After adjusting for patient age, body mass index, PCOS, homeostasis model assessment-insulin resistance index, and serum testosterone levels, we found that body mass index ≥25 kg/m2 (HR=0.583; 95% CI=0.365–0.932; p=0.024) and PCOS (HR=0.545; 95% CI=0.324–0.917; p=0.022) were significantly correlated with lower 16-week CR rate. @*Conclusion@#PCOS was associated with lower 16-week CR rate, longer treatment duration and shorter recurrence interval in patients with AEH or EEC receiving fertility-preserving treatment.

Retraction: Differential expression of exosomal miRNAs in osteoblasts in osteoarthritis Journal of Central South University. Medical Science, 2018, 43(12):1294-1300. DOI: 10.11817/j.issn.1672-7347.2018.12.003 / 中南大学学报(医学版)

The article entitled "Differential expression of exosomal miRNAs in osteoblasts in osteoarthritis" published on Journal of Central South University (Medical Science), in Volume 43, Issue 12, 2018 (DOI: 10.11817/j.issn.1672-7347.2018.12.003) may have an unclear risk of bias due to insufficient understanding for some results. Further experimental studies are needed. We all agree to retract this article, and apologize to the Journal and readers for the possible negative impact.

Analysis of risk factors and outcomes for delayed gastric emptying following pancreaticoduodenectomy: a single center experience of 492 cases / 中华外科杂志

Objective@#To evaluate risk factors for delayed gastric emptying(DGE)following pancreaticoduodenectomy(PD).@*Methods@#There were 492 consecutive patients who underwent PD in Pancreas Center, the First Affiliated Hospital with Nanjing Medical University between January 2012 and December 2014 were identified from a prospective database.There were 315 male and 177 female patients with a median age of 60.5 years.Univariate and multivariate analyses were performed to investigate the independent risk factors for clinically relevant DGE(CR-DGE).@*Results@#The overall incidence of DGE was 29.5%, with Grade B and C occurring at 4.3% and 5.9%, respectively.In multivariate analysis, pancreatic duct diameter less than 3 mm(OR=1.888, P=0.042), pylorus-preserving pancreaticoduodenectomy(OR=2.627, P=0.005) and clinically relevant postoperative pancreatic fistula(OR=2.740, P=0.007) were independently associated with CR-DGE.Other main complications such as postoperative pancreatic fistula, pyoperitoneum, intraabdominal infection were also associated with the severity of DGE(χ2=21.360, 14.422, 14.378; P=0.011, 0.002, 0.002). DGE patients had a significantly prolonged postoperative length of stay(31(24-41)d vs. 13(11-17)d) and increased medical cost((122 367.5±66 068.3)yuan vs. (78 200.7±27 043.9)yuan)(both P<0.01).@*Conclusions@#Small pancreatic duct, underwent pylorus-preserving pancreaticoduodenectomy and suffered postoperative pancreatic fistula might indicate a high risk of CR-DGE.

Differential expression of exosomal miRNAs in osteoblasts in osteoarthritis / 中南大学学报(医学版)

To analyze the differentially expressed exosomal miRNAs in subchondral osteoblasts in patients with osteoarthritis (OA) and to investigate the key miRNAs potentially involved in the occurrence and progression of OA.
 Methods: Subchondral bones were harvested from 6 patients with OA. All subjects were divided into two groups which was based on the severity of joint wear: An OA group, severely worn side of subchondral bone, and a control group, less worn side of subchondral bone. The exosomes were extracted from osteoblast cells and their characteristics were identified. Then exosomal miRNAs were extracted and sequencing analysis was conducted to compare the expression in the two groups. The most differentially expressed ones (log2Ratio≥2) were subject to miRNA target prediction and quantitative reverse transcription PCR (RT-qPCR) to further quantify the difference.
 Results: Osteoblast extractions were confirmed to be exosomes, which were small double-membranous vesicles with 30-200 nm in diameter and 50-150 nm in peak value of particle size under the scanning microscope. High-throughput sequencing revealed 124 miRNAs whose expression significantly increased in the OA group. The most differentially expressed one with maximum fold change was hsa-miR-4717-5p and its target gene was RGS2. RT-qPCR demonstrated hsa-miR-4717-5p expression in the OA group was relatively higher than that in the control group (2.243 vs 0.480, P<0.01).
 Conclusion: There is distinct difference in expression profiles of exosomal miRNAs in subchondral osteoblasts between patients with OA and normal subjects. Up-regulated expression of miRANs might participate in OA occurrance and progression.

B-cell chronic lymphoproliferative disorders: a clinical analysis of 40 cases / 白血病·淋巴瘤

Objective@#To investigate the clinical features, treatment and prognosis of the patients with B-cell chronic lymphoproliferative disorders (B-CLPD).@*Methods@#The data of 40 patients with B-CLPD in the Third People's Hospital of Kunshan from September 2010 to June 2017 were retrospectively analyzed, including clinical features, laboratory inspections, immunophenotyping, genetics and molecules results, therapeutic regimens, evaluation of curative effect and disease outcome.@*Results@#There were 29 male and 11 female patients in 40 B-CLPD patients, with a median age of 71.5 years old (47-88 years old). The percentage of chronic lymphocytic leukemia (CLL) was 57.5% (23/40), monoclonal B lymphocytosis was 10.0% (4/40), Waldenstrom macroglobulinemia was 15.0% (6/40), marginal/splenic marginal zone lymphoma was 12.5% (5/40), and mantle cell lymphoma was 5.0% (2/40). The immunophenotyping of the whole patients had the expressions of CD19, and surface immunoglobulin light chain in cytomembrane of 37 patients had a restrictive expression. All CLL patients presented the expressions of CD5 and CD23, while the other types of B-CLPD expressed various level of CD20, CD22, CD10, CD5, FCM-7. Twenty-six patients received chemotherapies including purine analogue, anthracyclines, alkylating agents and hormone. The overall response rate (complete remission plus partial remission) was 69.2% (18/26). The complete remission rate was 15.4% (4/26), which only occurred in the cohort of CLL patients who received the regimen containing fludarabine. The median follow up time of 26 patients who received medical treatment was 42.8 months (0.5-82.0 months), not reaching the median survival time.@*Conclusions@#The clinical features of B-CLPD are various, which requires comprehensive analysis of clinical data, including medical history, laboratory findings, imageological examination, cell morphology, immunophenotyping, genetics as well as molecular biology. The choice of the treatment should take the individualized situation into consideration.

Portal and superior mesenteric vein resection in radical pancreatectomy for pancreatic cancer / 中华消化外科杂志

Radical resection remains essential for prolonging survival and increasing the possibility of cure in pancreatic cancer.However,few patients are resectable at the time of diagnosis,with a portion of patients presenting with portal and superior mesenteric vein invasion and regarded as resectable or locally advanced disease.Venous resection in pancreatectomy enables achievement of tumor-free margins in patients with venous invasion.This review provides an overview of preoperative evaluation,resection and reconstruction types,vascular grafts selection,morbidity,mortality and survival in radical pancreatectomy with portal and superior mesenteric vein resection.

A comparative analysis of the efficacy and prognosis of concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy for stageⅡB-ⅢBcervical squamous cell carcinoma / 中华放射肿瘤学杂志

Objective To investigate the long-term efficacy and prognosis of concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy for stage ⅡB-ⅢB cervical squamous cell carcinoma. Methods A retrospective analysis was performed among 171 patients with stage ⅡB-ⅢBcervical squamous cell carcinoma who were admitted to our hospital and had complete follow-up data from February 1,2005 to October 31,2011. Results The median follow-up time was 66 months. There were no significant differences in the 3-or 5-year overall survival rates between the concurrent group and the neoadjuvant group(81.4% vs.75.9%,74.3% vs.67.2%,P=0.469).According to the subgroup analysis,there was no correlation between lymph node metastasis and survival curve(P=0.310,P=0.151).The univariate and Cox multivariate analyses showed that tumor size,lymph node metastasis,and concurrent chemotherapy method were independent prognostic factors for cervical cancer(P<0.05).For the patients with lymph node metastasis, the neoadjuvant group had a significantly higher pelvic local recurrence rate than the concurrent group (P=0.047),while there were no significant differences in mortality,distant metastasis,or long-term adverse reactions between the two groups(all P>0.05).For the patients without lymph node metastasis,the neoadjuvant group had a significantly higher incidence of grade 3-4 bone marrow suppression than the concurrent group (P=0.016), while there were no significant differences in mortality,local recurrence,distant metastasis,or long-term adverse reactions between the two groups (all P>0.05). Conclusions Concurrent chemoradiotherapy alone and concurrent chemoradiotherapy after neoadjuvant chemotherapy achieve similar treatment outcomes in patients with stage ⅡB-ⅢBcervical squamous cell carcinoma,no matter whether they have lymph node metastasis or not. Tumor size,lymph node metastasis,and concurrent chemotherapy method are independent prognostic factors.Neoadjuvant chemotherapy increases the risk of grade 3-4 marrow suppression during concurrent chemoradiotherapy,prolongs irradiation time,and increases the risk of local recurrence.

Serum level and clinical significance of macrophage inflammatory protein-1α and interferon ;gamma inducible protein-10 in acute myelogenous leukemia / 中国医师进修杂志

Objective To study the serum level of macrophage inflammatory protein-1α(MIP-1α) and interferon gamma inducible protein-10 (IP-10) in acute myelogenous leukemia (AML) and clarify their clinical significance. Methods Enzyme-linked immunosorbent assay was used to detect the level of MIP-1α and IP-10 in serum samples from 34 AML patients(observation group) and 20 volunteers (normal control group). Results The levels of MIP-1αand IP-10 in observation group before induction chemotherapy were significantly higher than those in normal control group (P<0.05). The levels of MIP-1αand IP-10 in observation group after induction chemotherapy were decreased, and significantly lower than those before induction chemotherapy (P<0.05). After treatment for one course, 21 patients reached complete remission (CR), and 13 patients did not reach CR. The levels of MIP-1αand IP-10 in CR group had no significant difference compared with those in normal control group (P<0.05), but the levels of MIP-1αand IP-10 in none CR group were significantly higher than those in normal control group and CR group (P<0.05). The drop percentage of MIP- 1αlevels in CR group and none CR group was (32.51 ± 10.34)% and (10.57 ± 10.39)%, and there was significant difference (P<0.05). The drop percentage of IP-10 levelsin CR group and none CR group was(45.94 ± 13.68)% and (31.17 ± 11.85)%, and there was significant difference (P<0.05). Liner correlation analysis revealed that the levels of MIP-1αand IP-10 had significantly positive correlation in AML patients (r=0.652, P<0.05). Conclusions Different expressions of serum MIP-1α and IP-10 are found before and after induction chemotherapy AML patients, and there is significant correlation. Combined detection of serum MIP-1αand IP-10 may be used as an index to monitor clinical stages and prognosis.

Micro?surgical Treatment of Medulla Oblongata Cavernomas / 中国医科大学学报

Objective To investigate the efficacy of micro?surgery for the treatment of medulla oblongata cavernomas. Methods A retrospective analysis was conducted on the clinical data of 21 patients with cavernous hemangioma who received micro?surgical treatment. Of the 21 patients, 13 were men and 8 women,aged 22 to 63 years. The preoperative Karnofsky performance status(KPS)score was 76.5 ± 10.2. The main clinical manifestations included sensory disorder and difficulty swallowing etc. According to the location of the lesions ,the posterior transchoroidal fissure approach was employed for 16 patients;far?lateral approach,5 patients. Electrophysiological monitoring and nervous system navigation were supple?mentarily adopted in both types of surgery. Further ,KPS scoring was conducted to evaluate the patients 'quality of life. Results The medulla cav?ernous hemangioma was excised in all cases. For 17 patients with primary neurological disorders ,their symptoms were alleviated or resolved;4 pa?tients had severe symptoms and 8 presented with new clinical symptoms. A follow?up visit was conducted 8 to 97 months post?surgery(average 47.6 months). All patients were found capable of caring for themselves in daily life and performing simple or normal learning and working activities without recurrence or bleeding. The mean postoperative KPS score was 83.7 ± 15.5. Conclusion Patients with medulla cavernous hemangioma bleeding or severe symptoms should actively seek surgical treatment. Repeated bleeding is the absolute indication for surgery. Surgical skills ,elec?trophysiological monitoring,and nervous system navigation can reduce nervous system damage and protect the brainstem. The patient's quality of life is expected to significantly improve after surgery.

The effects of vorinostat on erlotinib-resistance of lung adenocarcinoma cells / 安徽医科大学学报

Objective To investigate the impact of vorinostat(SAHA) on the erlotinib-resistance of human lung adenocarcinoma cell line PC-9/ER.Methods PC-9/ER cells were treated with erlotinib and SAHA,alone or in combination.The effects of proliferation inhibition were assayed by MTT method,the apoptosis ratios of cells were analyzed by flow cytometry.Results The results showed that SAHA inhibited the proliferation of PC-9/ER cells in a dose-dependent manner alone.The non-toxic doses of SAHA (1 μmol/L) significantly improved the sensitivity of PC-9/ER to Erlotinib,and induce apoptosis.Conclusion SAHA could partially improve PC-9/ER sensitivity to erlotinib.

CT features of dear cell papillary renal cell carcinoma / 中国医师杂志

Objective To investigate the computed tomography (CT) features of clear cell papillary renal cell carcinoma (CCPRCC).Methods The CT features of 6 patients with CCPRCC were analyzed retrospectively.The size,location,growth pattern,shape,texture,calcification,necrosis,hemorrhage,CT value,enhancement form and enhancement degree of the tumor and perirenal lymph nodes were observed.Results All 6 cases of CCPRCC were solitary lesions,of which 3 were located in the left kidney and 3 in the right kidney.Maximum tumor diameter ranged from 1.5 cm to 4.0 cm.The tumor margin was well-defined in 4 cases and ill-defined in two cases.All tumors showed expansive growth without invasion.There were three cases of endophytic growth and three cases of exophytic growth.Regarding tumor composition,only one case was cystic and the other five cases were solid.No calcification,necrosis and hemorrhage occurred in all the tumors.The CT value of tumors in unenhanced phase ranged from 31.2 HU to 42.5 HU.During the enhanced CT scan,5 cases showed highly enhancement and 1 case showed moderate enhancement.The CT value of tumors in corticomedullary phase ranged from 75.1 HU to 150.1 HU.In nephrographic phase,the enhancement degree in 1 case continued to increase,but it decreased in the other 5 cases.The CT value ranged from 73.3 HU to 102.2 HU.The enhancement degree in all 6 cases decreased in excretory phase and the CT value ranged from 52.6 HU to 79.1 HU.In the aspect of tumor enhancement form,only one case showed homogeneous enhancement and the other five cases showed heterogeneous enhancement.In addition,the peripheral renal lymph nodes were not enlarged in all patients,and no tumor invasion or tumor thrombus formation occurred in the renal vein.Conclusions CCPRCC has a relatively specific CT features that are easily distinguished from papillary renal cell carcinoma or chromophobe renal cell carcinoma,but it is difficult to identify from early-stage clear cell renal cell carcinoma.

Research on the effect of endoscopic single nostril transsphenoidal pituitary tumor resection / 局解手术学杂志

Objective To discussion the effect of endoscopic single nostril transsphenoidal pituitary tumor resection on improving clini-cal symptoms and related quality of life of patients. Methods Selected 114 cases of patients with pituitary tumors in our hospital from August 2013 to August 2015, and randomly divided them into the nasal endoscopic group and the microscopic group according to the random number table,with 57 patients in each group. Patients of the 2 groups were treated with nasal endoscopic and microscopic single nostril transsphenoi-dal pituitary tumor resection respectively. The operation situation,hormone decline,incidence of complications after surgery and SNOT-20 and VAS score of the two groups were compared. Results Operative time of nasal endoscopic group was significantly higher than that in the mi-croscopic group,whlie the blood loss,length of hospital stay in endoscopic group was significantly lower than the microscopic group,and the difference was statistically significant (P0. 05). One week after operation,cerebrospinal fluid cell count,cerebrospinal fluid protein,adrenocorticotropic hormone,serum chloride,sodium, growth hormone,and prolactin levels of the nasal endoscopic group were lower than the microscopic group (P<0. 05). The complication rate was 14. 9% in the nasal endoscopic group,which was obviously lower than 59. 6% in the microscopic group (P<0. 05). One week after operation,the SNOT-20 scores and VAS scores were increased in both of the two groups,but the microscopic group increased more significantly (P<0. 05). Conclusion Endoscopic single nostril transsphenoidal pituitary tumor resection surgery cost longer operation time,but it lead to less trauma and less postoperative complications,which may delay the decline of patients’ quality of life and promote the improvement of prognosis.

Expression and clinical significance of macrophage inflammatory protein -1α,interferon gamma inducible protein 10 and angiopoietin-1 in primary acute myelogenous leukemia / 中国基层医药

Objective To study the expression of macrophage inflammatory protein-1α(MIP-1α),inter-feron gamma inducible protein 10(IP -10)and angiopoietin -1 (Ang -1)in primary acute myelogenous leukemia (AML),and clarify their clinical significance.Methods ELISA was used to detect the expressions of MIP -1α,IP-10 and Ang -1 in serum samples from 54 AML patients(observation group),and twenty volunteers(normal control group).Results The expression levels of MIP -1α,IP -10 and Ang -1 in the observation group[(198.813 ± 53.923)pg/mL,(2.332 ±0.745)ng/mL,(1.593 ±0.447)ng/mL]were significantly higher than the normal control group[(153.309 ±44.475)pg/mL,(1.569 ±0.485)ng/mL,(0.838 ±0.333)ng/mL](t =3.369,5.133,6.856, all P 0.05).There were remarkable correlation between the serum expression levels of MIP -1αand Ang -1 (r =0.324,P <0.05).Conclusion There are differences of serum MIP -1α, IP -10 and Ang -1 in the different NCCN prognosis groups,which reflect they may have certain guiding significance in the choice of clinical treatment and the prognosis for newly diagnosed AML.

Signaling pathway inhibitors of calcineurin-nuclear factor of activated T cells:research progress / 中国药理学与毒理学杂志

Calcineurin (CaN) serves as a key enzyme in human immune regulation. The most important target of this enzyme is the transcription factors of nuclear factors of activated T cells (NFATc). The discovery of the immunosuppressive function of CaN inhibitors (CNIs),ciclosporin A (CsA) and tacrolimus (FK506),has helped overcome the immune rejection of organ transplantion and changed organ transplantion fundamentally. Both of these drugs are still widely used in clinical and basic research,but their therapeutic effects are limited by their serious side effects,including renal tox?icity and neurotoxicity. Therefore,the development of new CNIs with higher specificity and fewer side effects in the clinic is a focus of research. In this paper,the newly discovered and synthesized CNIs in recent decades,including the CsA and FK506 derivatives,direct inhibitors of CaN,as well as the inhibitors that specifically interfere with CaN-NFATc interaction,were summarized.

S-palmitoylation regulates AMPA receptors trafficking and function: a novel insight into synaptic regulation and therapeutics

Glutamate acting on AMPA-type ionotropic glutamate receptor (AMPAR) mediates the majority of fast excitatory synaptic transmission in the mammalian central nervous system. Dynamic regulation of AMPAR by post-translational modifications is one of the key elements that allow the nervous system to adapt to environment stimulations. S-palmitoylation, an important lipid modification by post-translational addition of a long-chain fatty acid to a cysteine residue, regulates AMPA receptor trafficking, which dynamically affects multiple fundamental brain functions, such as learning and memory. In vivo, S-palmitoylation is controlled by palmitoyl acyl transferases and palmitoyl thioesterases. In this review, we highlight advances in the mechanisms for dynamic AMPA receptors palmitoylation, and discuss how palmitoylation affects AMPA receptors function at synapses in recent years. Pharmacological regulation of S-palmitoylation may serve as a novel therapeutic strategy for neurobiological diseases.

Induced pluripotent stem cell therapy：transplant rejection and safety / 中国组织工程研究

BACKGROUND:Induced pluripotent stem cels have been a hotspot in regenerative medicine research since it was discovered. The clinical application of induced pluripotent stem cels is excessively focused on, but the safety issue is almost ignored. OBJECTIVE:By summarizing the application of induced pluripotent stem cels in animal experiments to analyze the safety problems of induced pluripotent stem cels and their possible reasons in order to lay a foundation for further study and clinical application of induced pluripotent stem cels. METHODS: PubMed database was retrieved by the first author for articles related to the safety of induced pluripotent stem cels published from 2006 to 2014 using the keywords of “induced pluripotent stem cels, safety, immune, immunogenicity, tumorigenicity, cancer, epigenomic, transplantation, generation, reprogramming,genomic, mutation” in English. Related ful texts were got from Cel Press and Nature Databases. Finaly, 28 articles were chosen in result analysis. RESULTS AND CONCLUSION: Safety problems of induced pluripotent stem cels are attracting more and more attentions. Immunogenicity, potential tumorigenicity and epigenetic variation are major risks for the clinical applications of induced pluripotent stem cels. Safety issues of induced pluripotent stem cels mainly come from the reprogramming process. The “integrating genetic manipulation” may lead to a greater risk of tumorigenicity than non-integrating operations. Epigenetic variations emerge in the reprogramming, which are mostly relative to “epigenetic memory” of reprogrammed cels.