Distal tibiofibular syndesmosis fibular notch typing and its clinical significance based on CT / 解剖学报

Objective To investigate the morphological typing and clinical significance of the distal tibiofibular syndesmosis fibular notch based on CT images. Methods According to the inclusion and exclusion ceiteria‚ the imaging data of patients undergoing ankle joint CT examination were analyzed‚ and the inferior tibiofibular joint fibula notch was classified according to the morphological characteristics. The measurements included 8 distances. There were 123 males and 102 females‚ all of whom were Han nationality‚ aged 18-60 years old. Results Retrospectively analyzed the result of 225 patients from December 2013 to December 2022. The distal tibiofibular syndesmosis fibular notch was divided into four types according to morphological characteristics‚ C-shaped (50. 67%)‚ V-shaped (26. 67%)‚ flat-shaped (15. 11%) and L-shaped (7. 56%). The angle between the anterior and posterior facets of the flat shape (145. 56 ± 9. 25)° was the largest and the angle between the anterior and posterior facets of the L shape (125. 07 ± 13. 54)° was the smallest(P< 0. 05); the depth of the notch in the flat shape (3. 11 ± 0. 83) mm was the smallest and in the L shape (4. 47±1. 11) mm was the largest(P<0. 05);The posterior facet length (13. 06 ± 3. 56) mm and anterior tibiofibular gap (3. 83±1. 49) mm on left were larger than on the right side (P<0. 05); The posterior facet length (13. 36 ± 3. 46) mm‚ fibular notch depth (3. 93 ± 1. 10) mm and vertical distance of tibiofibular overlap (9. 10 ± 2. 55) mm larger in men than in women (P<0. 05). Conclusion In this study‚ the data related to the inferior tibiofibular syndesmosis notch were measured and divided into four types according to the shape. The flat inferior tibiofibular syndesmosis notch is more likely to have chronic ankle instability‚ and the fibula is more likely to move forward during anatomical reduction. The inferior tibiofibular syndesmosis of L-shaped and C-shaped notches is more prone to posterior displacement of fibula or poor rotation reduction during anatomical reduction.

Clinical Characteristics and Obstetric Outcomes of Pregnant Women Who Underwent Surgery for Adnexal Torsion / 中山大学学报(医学科学版)

ObjectiveTo explore the clinical characteristics and obstetric outcomes of pregnant women who underwent surgery for adnexal torsion at different gestational weeks. MethodsA retrospective study was done on 39 women who underwent surgery for adnexal torsion during pregnancy in the First Affiliated Hospital， Sun Yat-sen University between March 2013 and March 2023， with 18 cases in 1st trimester （<14 weeks）， 11 in 2nd trimester （14-27+6 weeks） and 10 in 3rd trimester （≥28 weeks）. The clinical characteristics， treatment and obstetric outcomes were compared among the three groups. ResultsThe 1st trimester group had higher proportion of assisted reproductive technology （ART） use than the 2nd and 3rd trimester groups （P=0.026）. There was no significant difference in the clinical manifestations， including abdominal pain， nausea， vomiting and fever among the three groups， while elevated white blood cells （WBC） counts was more commonly seen in the 2nd and 3rd trimester groups. Adnexal masses <5 cm in diameter occurred in 0， 18.2%， and 10.0% of cases in 1st， 2nd and 3rd trimester groups respectively （P=0.014）. No statistical significance was found in the location of twisted adnexa， number of circles or pathological nature. The 1st trimester group had a higher sensitivity of ultrasound in the diagnosis of adnexal torsion compared with the 2nd and 3rd trimester groups （77.8%， 36.4%， 20.0%； P=0.008）. More laparoscopic surgery were performed in the 1st trimester group than the other two groups （55.6% ， 27.3%， 0.0%； P=0.008）. There was no significant difference in gestational week of delivery， delivery mode， newborn gender， neonatal birth weight and follow-up of newborns among the three groups. The 3rd trimester group showed a higher risk of preterm delivery （P=0.050）. ConclusionsDuring the 1st trimester of pregnancy， adnexal torsion is more common in patients using ART and ultrasound plays a crucial role in the diagnosis. During the 2nd and 3rd trimester， adnexal torsion should be suspected in patients with abdominal pain and elevated WBC but no aspetic inflammation. Laparoscopic surgery is safe for adnexal torsion during pregnancy and can achieve a favorable maternal and neonatal outcome.

The value of cardiac MRI in the risk stratification in patients with hypertrophic cardiomyopathy / 中华心血管病杂志

Objective: To explore the value of cardiac magnetic resonance imaging (CMR) in the risk stratification of hypertrophic cardiomyopathy (HCM). Methods: HCM patients who underwent CMR examination in Fuwai Hospital between March 2012 and May 2013 were retrospectively enrolled. Baseline clinical and CMR data were collected and patient follow-up was performed using telephone contact and medical record. The primary composite endpoint was sudden cardiac death (SCD) or and equivalent event. The secondary composite endpoint was all-cause death and heart transplant. Patients were divided into SCD and non-SCD groups. Cox regression was used to explore risk factors of adverse events. Receiver operating characteristic (ROC) curve analysis was used to assess the performance and the optimal cut-off of late gadolinium enhancement percentage (LGE%) for the prediction of endpoints. Kaplan-Meier and log-rank tests were used to compare survival differences between groups. Results: A total of 442 patients were enrolled. Mean age was (48.5±12.4) years and 143(32.4%) were female. At (7.6±2.5) years of follow-up, 30 (6.8%) patients met the primary endpoint including 23 SCD and 7 SCD equivalent events, and 36 (8.1%) patients met the secondary endpoint including 33 all-cause death and 3 heart transplant. In multivariate Cox regression, syncope(HR=4.531, 95%CI 2.033-10.099, P<0.001), LGE% (HR=1.075, 95%CI 1.032-1.120, P=0.001) and left ventricular ejection fraction (LVEF) (HR=0.956, 95%CI 0.923-0.991, P=0.013) were independent risk factors for primary endpoint; Age (HR=1.032, 95%CI 1.001-1.064, P=0.046), atrial fibrillation (HR=2.977, 95%CI 1.446-6.131, P=0.003),LGE% (HR=1.075, 95%CI 1.035-1.116, P<0.001) and LVEF (HR=0.968, 95%CI 0.937-1.000, P=0.047) were independent risk factors for secondary endpoint. ROC curve showed the optimal LGE% cut-offs were 5.1% and 5.8% for the prediction of primary and secondary endpoint, respectively. Patients were further divided into LGE%=0, 0<LGE%<5%, 5%≤LGE%<15% and LGE%≥15% groups. There were significant survival differences between these 4 groups whether for primary endpoint or secondary endpoint (all P<0.001) and the accumulated incidence of primary endpoint was 1.2% (2/161), 2.2% (2/89), 10.5% (16/152) and 25.0% (10/40), respectively. Conclusion: LGE is an independent risk factor for SCD events as well as all-cause death and heart transplant. LGE is of important value in the risk stratification in patients with HCM.

Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome / 中山大学学报(医学科学版)

ObjectiveTo summarize and analyze the clinical characteristics， diagnosis process， treatment process， and obstetric outcomes of pregnant women with Cushing's syndrome， helping to optimize pregnancy management. MethodsA retrospective study was conducted on 8 pregnant women with Cushing’s syndrome who were hospitalized in the First Affiliated Hospital， Sun Yat-sen University between January 2006 and August 2022. The clinical characteristics， management and obstetric outcomes were recorded. ResultsPreeclampsia was detected in 4 cases，pre-gestational diabetes mellitus in 2 cases， gestational diabetes mellitus in 5 cases， and hypokalemia in all 8 cases. Elevated serum cortisol， disappearance of day-night rhythm of cortisol， increased 24-hour urine cortisol and decrease in serum ACTH were found in 8 cases by laboratory examination. Furthermore， adrenal adenoma was detected in all 8 cases by ultrasonography or Magnetic Resonance Imaging. Three cases underwent laparoscopic adrenalectomy in the second trimester and 4 cases received surgery after delivery. The diagnosis of adrenal cortical adenoma was confirmed by pathological report. Six cases had preterm birth， while one patient delivered after 37 weeks of gestation and one patient suffered from spontaneous abortion. Among 7 cases of live birth， 6 patients underwent cesarean section and 1 patient had vaginal delivery. Of all newborns， 3 had low birth weight. One case had a birth defect. Four infants were transferred to the neonatal intensive care unit， and two infants died. One child was diagnosed with nephrotic syndrome at 2 years of age. ConclusionsCushing's syndrome is rare and high risk during pregnancy. It requires multidisciplinary diagnosis， treatment， and long-term follow-up. Drug therapy carries a risk of progression and requires intensive care during pregnancy， postpartum follow-up， and specialist treatment.

Anatomical continuity between the iliotibial tract and the fibular myofascial fascia / 解剖学报

Objective To provide evidence for the presence of the lower body fascia chain. Methods Totally 20 cases of Chinese adult femur were selected, and the anatomy was performed to observe the continuity on fascia between periosteal fascia and iliotibial tract (ITT). Judging the generic character and the degree of continuity of them. If there was a significant anatomical continuity between them, the tensile strength of the structure is tested by applying a certain tension to both. Results First, an indirect link between the iliotibial tract and the fibular myofascial fascia was found: in all anatomical lower extremity specimens, the iliotibial bundle (ITT) was structurally connected to the fascial fascia, which was almost inseparable from the fibular fascia. Second, the application of tension to the iliotibial tract (ITT) could cause local movement between the fascia of the calf and the periosteal fascia. Conclusion Iliotibial tract and fibular long muscle fascia are connected firmly. The stability of the connection suggests that it may play a role in the conduction of a certain tension.

Characteristics of amino acid metabolism in myeloid-derived suppressor cells in septic mice / 北京大学学报(医学版)

OBJECTIVE@#To explore the amino acid metabolomics characteristics of myeloid-derived suppressor cells (MDSCs) in mice with sepsis induced by the cecal ligation and puncture (CLP).@*METHODS@#The sepsis mouse model was prepared by CLP, and the mice were randomly divided into a sham operation group (sham group, n = 10) and a CLP model group (n = 10). On the 7th day after the operation, 5 mice were randomly selected from the surviving mice in each group, and the bone marrow MDSCs of the mice were isolated. Bone marrow MDSCs were separated to measure the oxygen consumption rate (OCR) by using Agilent Seahorse XF technology and to detect the contents of intracellular amino acids and oligopeptides through ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) technology. Different metabolites and potential biomarkers were analyzed by univariate statistical analysis and multivariate statistical analysis. The major metabolic pathways were enriched using the small molecular pathway database (SMPDB).@*RESULTS@#The proportion of MDSCs in the bone marrow of CLP group mice (75.53% ± 6.02%) was significantly greater than that of the sham group (43.15%± 7.42%, t = 7.582, P < 0.001), and the basal respiratory rate [(50.03±1.20) pmol/min], maximum respiration rate [(78.07±2.57) pmol/min] and adenosine triphosphate (ATP) production [(25.30±1.21) pmol/min] of MDSCs in the bone marrow of CLP group mice were significantly greater than the basal respiration rate [(34.53±0.96) pmol/min, (t = 17.41, P < 0.001)], maximum respiration rate [(42.57±1.87) pmol/min, (t = 19.33, P < 0.001)], and ATP production [(12.63±0.96) pmol/min, (t = 14.18, P < 0.001)] of sham group. Leucine, threonine, glycine, etc. were potential biomarkers of septic MDSCs (all P < 0.05). The increased amino acids were mainly enriched in metabolic pathways, such as malate-aspartate shuttle, ammonia recovery, alanine metabolism, glutathione metabolism, phenylalanine and tyrosine metabolism, urea cycle, glycine and serine metabolism, β-alanine metabolism, glutamate metabolism, arginine and proline metabolism.@*CONCLUSION@#The enhanced mitochondrial oxidative phosphorylation, malate-aspartate shuttle and alanine metabolism in MDSCs of CLP mice may provide raw materials for mitochondrial aerobic respiration, thereby promoting the immunosuppressive function of MDSCs. Blocking the above metabolic pathways may reduce the risk of secondary infection in sepsis and improve the prognosis.

Classification of hepatocellular carcinoma diameter by statistical technology and prognostic evaluation in patients after the combined use of transarterial chemoembolization and radiofrequency ablation

Objective: This study aimed to classify hepatocellular carcinomas (HCCs) according to their diameter using statistic technology and evaluate the prognosis of the classified groups after the combined use of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). Materials and Methods: Electronic medical records of 128 consecutive patients who underwent TACE-RFA as the initial treatment for HCC from January 2010 to April 2018 were retrospectively analyzed. TACE was initially performed with subsequent RFA performed after 3–7 days. The decision tree model was used to classify overall survival (OS), progression-free survival (PFS), local recurrence rate (LRR), and treatment complications in HCC. Results: The tumors were divided into three groups of sizes ≤2.9 cm, 2.9–4.8 cm, and >4.8 cm. The group of tumors >4.8 cm showed inferior OS, PFS, and LRR than the other two groups (P < 0.05) on long-term follow-up but not in thefirst 6 months (P > 0.05). The groups of tumors ≤2.9 cm and 2.9–4.8 cm showed no statistically significant difference in OS, PFS, and LRR (P > 0.05). Conclusions: The cutoff points of 2.9 and 4.8 cm were achieved using the objective decision tree model rather than the artificial division of 3 and 5 cm. The prognosis was not significantly different between the groups of tumors ≤2.9 cm and 2.9–4.8 cm, and the prognosis of the two groups was better than the group of tumors >4.8 cm in the long-term follow-up but not in thefirst 6 months

Effects of keto acid supplements on Chinese patients receiving maintenance hemodialysis: a prospective, randomized, controlled, single-center clinical study / 中华医学杂志(英文版)

BACKGROUND@#The effects of keto acid (KA) supplements on Chinese patients receiving maintenance hemodialysis (MHD) are unclear. This study aimed to evaluate the effects of KA supplementation on nutritional status, inflammatory markers, and bioelectric impedance analysis (BIA) parameters in a cohort of Chinese patients with MHD without malnutrition.@*METHODS@#This was a prospective, randomized, controlled, single-center clinical study conducted in 2011 till 2014. Twenty-nine patients with MHD were randomly assigned to a control (n = 14) or a KA (n = 15) group. The control group maintained a dietary protein intake of 0.9 g/kg/day. The KA group received additional KA supplement (0.1 g/kg/day). BIA was used to determine the lean tissue mass, adipose tissue mass, and body cell mass. The patients' nutritional status, dialysis adequacy, and biochemical parameters were assessed at the ends of the third and sixth months with t test or Wilcoxon rank-sum test.@*RESULTS@#The daily total energy intake for both groups was about 28 kcal/kg/day. After 6 months, the Kt/V (where K is the dialyzer clearance of urea, t is the dialysis time, and V is the volume of the distribution of urea) was 1.33 ± 0.25 in KA group, and 1.34 ± 0.25 in the control group. The median triceps skin-fold thickness in KA group was 12.00 and 9.00 mm in the control group. In addition, the median hand-grip strength in KA group was 21.10 and 25.65 kg in the control group. There were no significant differences between the groups with respect to the anthropometry parameters, dialysis adequacy, serum calcium and phosphorus levels, inflammatory markers, and amino-acid profiles, or in relation to the parameters determined by BIA. Both groups achieved dialysis adequacy and maintained nutritional status during the study.@*CONCLUSIONS@#In this cohort of Chinese patients with MHD, the patients in the control group whose dietary protein intake was 0.9 g/kg/day and total energy intake was 28 kcal/kg/day, maintained well nutritional status during study period. The KA supplement (0.1 g/kg/day) did not improve the essential amino acid/non-essential amino acid ratio, nor did it change the patients' mineral metabolism, inflammatory parameters, or body compositions.

Advance in Muscle Strength Assessment for Critical Patients (review) / 中国康复理论与实践

The mechanism of muscle damage in critically ill patients mainly includes microcirculation disorder, changes in cells and metabolism, inflammation, increased myoprotein breakdown in muscular atrophy, and inactivation of ion channels. Manual muscle testing is the most commonly used muscle strength measurement for critically ill patients, which is simple and economic, but subjective, being not accurate and sensitive in evaluating muscle weakness of patients and distal limb function. Neuroelectrophysiological testing is safe, non-invasive, simple and objective, but it requires specialized equipment and trained qualified professionals, high medical costs, time and effort consumption, and lack of specificity. Dynamometer is a simple, objective, convenient and inexpensive assessment method, which has a good reliability and validity in application in the critically ill patients, but it is not widespread in China.

Inductive effect of solamargine on the apoptosis of human esophageal cancer KYSE150 cells and its action mechanism / 医学研究生学报

Objective Solamargine (SM), with its anti-inflammatory and anti-tumor effects, inhibits the proliferation and promotes the apoptosis of various tumor cells. This study was to investigate the effects of SM on the proliferation and apoptosis of human esophageal cancer KYSE150 cells and its action mechanism. Methods We treated KYSE150 cells with SM at the concentrations of 0 (the blank control group), 2, 4, 6 and 8 μmol/L for 24 hours. Then, we observed the morphological changes of the cells under the inverted microscope, detected their proliferation and apoptosis by MTT assay and flow cytometry respectively, and determined the expressions of the classical NF-κB signaling pathway-related proteins NF-κB, p-NF-κB, IKKα, IKKβ, IkBα and p-IkBα) and apoptosis-related proteins Bax, caspase-3, cleaved caspase-3 and Bcl-2 in different groups of the cells by Western blot. Results Compared with the blank control, the inhibition rate of the proliferation of the KYSE150 cells in the 2, 4, 6 and 8 μmol/L SM groups was increased significantly in a concentration-dependent manner (0 vs [15.03 ± 0.15]%, [47.94 ± 1.74]%, [68.72 ± 0.47]% and [77.51 ± 1.70]%, P<0.05), and so was the apoptosis rate ([8.17 ± 0.51]% vs [14.50 ± 0.73]%, [18.57 ± 2.08]%, [65.10 ± 10.88]% and [81.55 ± 5.48]%, P<0.05). The expression of the apoptosis-related protein Bax in the SM treated cells was up-regulated, those of Bcl-2, IKKα, IKKβ and p-IkBα down-regulated, and the activity of caspase-3 and cleaved caspase-3 promoted, all in a concentration-dependent manner, with statistically significant differences between the blank control and the 4, 6 and 8 μmol/L SM groups (P<0.05). Statistically significant differences were also found in the expressions of NF-κB, p-NF-κB and IkBα between the blank control and the 6 and 8 μmol/L SM groups (P<0.05). Conclusion Solamargine can significantly inhibit the proliferation and promote the apoptosis of KYSE150 cells, probably by suppressing the classical NF-κB signaling pathway.

The inhibition effects of allicin on TGF-β1 induced epithelial⁃mesenchymal transition of human cholangiocarcinoma cell and its mechanism / 医学研究生学报

Objective　The metastasis mechanism of cholangiocarcinoma is complex, which may be related to epithelial-mesenchymal transition(EMT). This study focused on investigating the inhibition effects of allicin on TGF-β1 induced epithelium mesenchymal transition of human cholangiocarcinoma cells and its related mechanism, and providing theoretical basis for the application of allicin in the treatment of cholangiocarcinoma.　Methods　MTT assay were used to detect the inhibition effects of different concentrations of allicin on the human cholangiocarcinoma RBE cell proliferation, and the drug concentration of allicin was determined by IC50 of 24 h. The RBE cells were cultured and divided into control group, allicin group(130.7μmol/L), TGF-β1 group(10ng/mL) and allicin+ TGF-β1 group(130.7μmol/L+10ng/mL). Wound scratch and transwell invasion assay were performed to detect the migration and invasion ability of RBE cells after 24 hours. Western blots were applied to detect expression of EMT-related proteins (E-Cadherin, N-Cadherin, Vimentin, Snail) and NF-κB signaling pathways.　Results　The migration rates in allicin group and allicin+ TGF-β1 group were both decreased compared with that in the control group ( 9.25% ± 0.36% vs 28.19 %±0.66%, P<0.05) and TGF⁃β1 group(13.91%±0.75% vs 49.22%±0.27%, P<0.05). The invasion rates in allicin group and allicin+ TGF-β1 group were also decreased compared with that in the control group (6.59%±0.06% vs 33.48%±0.04%, P<0.05) and TGF⁃β1 group(9.4%± 0.05% vs 40.21%±0.12%, P<0.05). Compared with the control group, E-Cadherin expression was significantly increased, and N-Cadherin, Vimentin, Snail, NF-κB and p-NF-κB expression were significantly decreased in the allicin group (P<0.05). Compared with TGF-β1 group, E-Cadherin expression was significantly up-regulated, and N-Cadherin, Vimentin, Snail, NF-κB and p-NF-κB expression were significantly down-regulated in the allicin+ TGF-β1 group (P<0.05)．　Conclusion　These results indicate that allicin can inhibit the EMT induced by TGF-β1 on the human cholangiocarcinoma cell by blocking NF-κB signaling pathway, which may have potential value to be the drug candidate for the treatment of human cholangiocarcinoma in future.

Construction of human telomerase reverse transcriptase periodontal ligament cell line mediated by adenovirus / 华西口腔医学杂志

OBJECTIVE@#This study aims to establish an effective and stable periodontal ligament cell line stably expressing human telomerase reverse transcriptase (hTERT) gene by using the adenovirus method.@*METHODS@#Polymerase chain reaction (PCR) was used to amplify the full length of hTERT gene to construct recombinant adenovirus plasmid pAd-pshuttle-cmv-hTERT. Packaged adenovirus particles were used for infection of human periodontal ligament cells. The expression levels of hTERT and osteogenic genes, such as alkaline phosphatase, Runt-related transcription factor 2, bone sialoprotein, osteocalcin, osteopontin, and collagen Ⅰ mRNA, were detected by quantitative real-time PCR (qRT-PCR). The ability of osteogenic differentiation was observed by alizarin red staining, and the cell proliferation was determined by CCK-8.@*RESULTS@#Adenovirus particles containing the hTERT gene were successfully constructed and infected with periodontal ligament cells. The infected cells were similar to normal periodontal ligament cells. The qRT-PCR results showed that hTERT and osteogenesis-associated genes were highly expressed in the periodontal ligament cell lines constructed by adenoviruses. Alizarin red staining showed that the periodontal ligament cell line had strong osteogenic differentiation capability. CCK-8 showed that the periodontal ligament cell line had strong proliferation capability.@*CONCLUSIONS@#The human periodontal ligament cell line with high efficiency and stable expression of hTERT was established by the adenovirus method, thereby providing an ideal cell line for studying the mechanism of periodontal regeneration.

Application of endoscopic retrograde cholangiopancreatography after Roux-en-Y reconstruction / 中国内镜杂志

Objective To evaluate the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y reconstruction. Methods 22 cases underwent ERCP after Roux-en-Y reconstruction from January 2015 to January 2017 were collected, the operating time, success rate of endoscopy and treatment, related complications were analyzed. Results ERCP was performed in 22 cases about Roux-en-Y reconstruction of digestive tract, the mean insertion and cannulation time was 74.1 and 22.5 minutes; the overall success rate was 81.8% (18/22) and 77.2% (17/22), and no major complications occurred. Conclusions ERCP can be used as a safe and effective method for the diagnosis and treatment on the Roux-en-Y reconstruction of digestive tract.

Progression in the diagnosis and treatment of Bile acid diarrhea / 医学研究生学报

Bile-acid diarrhoea(BAD)is a common cause of chronic diarrhoea,resulting from the excess amounts of bile acids enter the colon.The understanding of people about the cause of this diarrhea is still relatively limited for a variety of reasons.Clin-ically,75SeHCAT is the first-line diagnostic test,Other diagnostic tests including the measurement of serum 7α-hydroxy-4-cholesten-3-one(C4)、serum fibroblast growth factor 19(FGF19)、fecal bile acids and the empirical treatment of bile acid sequestrants(BAS). First-line treatment is with BAS for BAD,primarily cholestyramine,Newer BAS such as colestipol and colesevelam have fewer side effects. Obeticholic acid(OCA),as a new drug,maybe have a significant future.This article gives an overview on the etiology,pathogen-esis、diagnosis and treatment progress of BAD.

Pivotal factors concerned in design of acupuncture clinical research: From two articles in JAMA / 中国结合医学杂志

Two randomized controlled trials of acupuncture concerning polycystic ovary syndrome (PCOS) and stress urinary incontinence (SUI) were published simultaneously in the 24th issue, 2017 of The Journal of the American Medical Association (JAMA). A trial involving PCOS indicated that active acupuncture did not increase live birth compared with sham acupuncture; meanwhile, another trial referring to SUI showed that electroacupuncture resulted in less urine leakage compared with sham electroacupuncture. With an eye to the negative and positive results of acupuncture, three pivotal factors should be contemplated: (1) proper illness for acupuncture, that is, a problem need to be solved in current medical science, and acupuncture may really work for it; (2) proper pre-studied primary outcome, which is better be objective and repeatedly measurable to reveal the therapeutic effect of acupuncture truly and objectively; (3) proper sham control, which can blind the patients to the upmost extent with minimal biological effects. Through the publication of clinical trials of acupuncture in high-impact journals in recent years, researchers should have confidence in their clinical trials by pondering over these three pivotal factors.

Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy / 中国内镜杂志

Objective To evaluate the outcome of the laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy. Then define the characteristics of the learning curve of this procedure. Methods A prospectively collected database comprising all medical records of the first 79 consecutive patients underwent laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon was studied. The patients were divided into seven groups (13 cases in last group) by operative sequence. Data on patients' demographics, clinical and outcome variables including operative duration, conversion to open surgery, complications, and length of hospital stay were analyzed. The learning curve for the laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was established through the moving average and ANOVA methods. Results Comparing the early with the late experiences (33 v. 46 cases), the surgeon-specific outcomes significantly improved in terms of operating times [(292.7 ± 29.8) vs (215.3 ± 10.2) min, P < 0.05], There was four patients converted to open surgery in the early of experiences.the late experiences was five case, it was no statistical significance. significant differences were not shown in the hospitalization period and infectivity complications. Conclusion Operative duration can be reduced with increasing experience of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy, In this study, the learning curve for a laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was about thirty-three cases.

Application of Nucleic Acid Aptamers in Polypeptides Researches / 分析化学

Polypeptides play a vital role in physiological processes of life. The pharmacological and medical value of polypeptides has attracted the attention of researchers in recent years. Aptamers are short, single stranded DNA or RNA which developed by an in vitro process called systematic evolution of ligands by exponential enrichment ( SELEX ) . Aptamers can bind targets with high affinity and specificity. Hence, aptamer is also called "chemical antibody" or "chemist's antibody". To date, there are two main application aspects for polypeptides-targeted aptamers. First, aptamer can be used as specific affinitive elements based on their ability of recognition, which would be applied to polypeptides detection or imaging. The other one is that aptamer can also be used as antagonists based on their ability of inhibiting, which can restrict the activity of polypeptides and block the downstream signaling pathways in vivo, thus can be used to treat the disease associated with polypeptides. In this review, we summarize the numbers of polypeptides-targeted aptamers and the related applications in vitro and in vivo. Current issues and development trends throughout the screening, characterizing and applying of polypeptides-targeted aptamers are also discussed.

Characteristics of complete genome of pandemic A/H1N1/2009 influenza virus isolated in Fujian Province, China / 病毒学报

This study aims to investigate the characteristics of genomic variation of pandemic A/H1N1/2009 influenza virus isolated in Fujian Province, China. Complete genome sequence analysis was performed on 14 strains of pandemic A/H1N1/2009 influenza virus isolated from Fujian during 2009-2012. All virus strains were typical low-pathogenic influenza viruses, with resistance to amantadine and sensitivity to neuraminidase inhibitors. Eight genome fragments of all strains were closely related to those of A/California/07/2009 (H1N1) vaccine strain, with > or = 98.2% homology. Compared with the vaccine strain, the influenza strains from Fujian had relatively large variation, and variation was identified at 11 amino acid sites of the HA gene of A/Fujiangulou/SWL1155/2012 strain, including 4 sites (H138R, L161I, S185T, and S203T) involved inthree antigen determinants (Ca, Sa, and Sb). In conclusion, the influenza vaccine has a satisfactory protective effect on Fujian population, but the influenza strains from Fujian in 2012 has antigenic drift compared with the vaccine strain, more attention should therefore be paid to the surveillance of mutations of pandemic A/H1N1/2009 influenza virus.

Identification of splenic marginal zone lymphoma from B lymphoproliferative disorders by flow cytometry / 中国实验血液学杂志

The splenic marginal zone lymphoma (SMZL) is a relatively rare chronic B lymphoproliferative disease, which primarily manifest increase of peripheral blood lymphocyte count and/or scale, and splenomegaly, while the peripheral superficial lymph nodes are often not swollen. Therefore, the splenectomy are usually needed to confirm the diagnosis, but the majority of patients could not accept such management, resulting in early difficult diagnosis. This study was purposed to explore the more prior way for diagnosis based flow cytometry (FCM). Six patients with suspected diagnosis of SMZL were used as research objects, 10 healthy bone marrow donors and 10 cases of chronic lymphocytic leukemia (CLL), 3 cases of hairy cell leukemia (HCL), 3 cases of lymphatic plasma cell lymphoma/Waldenströ's macroglobulinemia (LPL/WM) were selected as control. The immunophenotype of bone marrow cells were analyzed and compared by FCM using a panel of antibodies including CD45, CD5, CD10, CD19, CD20, CD22, CD23, CD25, CD103, CD11c, CD123, κ,λ, Cyclin D1, and combined with bone marrow cell morphology. The results indicated that 6 cases of suspected SMZL showed a large increase of lymphocytes and splenomegaly. Because absence of peripheral lymphadenopathy, 6 patients did not suffer from lymph node biopsy, only 1 patient underwent diagnostic splenectomy. The immunophenotypes of bone marrow in patients and controls were analyzed by FCM, as a result, except for the healthy donors, varying degrees of abnormal mature B cell clones were found in bone marrow of all patients, and the further differentiation from other B-cell tumors was performed through CD5, CD10 expression and combination with other B-cell phenotype. All 6 cases of SMZL patients expressed CD19(+) and CD20(+), but CD10 expression was negative, 4 patients expressed CD5(-), 2 patients expressed CD5(+). The expressions of CD23, CD38, ZAP-70, CD11c, CD103, CD123, Cyclin D1 were negative. The morphological examination of bone marrow cells showed velutinous abnormal lymphocytes. Combined with clinical characteristics, 6 patients were diagnosed as SMZL, 1 patient suffered from splenectomy because of concurrent hypersplenism, and this postoperative pathologic examination confirmed the patient with SMZL. Ten cases of CLL mainly expressed CD5, CD23; 3 cases of HCL had more typical morphology of "hair like" in addition to CD11c, CD103 and CD123 positive; 3 cases of LPL/WM had significantly increased light chain restriction expression, IgM, plasmacytoid lymphocytes. It is concluded that the FCM immunophenotype analysis can be used as a powerful tools for clinical diagnosis of SMZL.

Regular intermittent bolus provides similar incidence of maternal fever compared with continuous infusion during epidural labor analgesia

To compare the effects of regular intermittent bolus versus continuous infusion for epidural labor analgesia on maternal temperature and serum interleukin-6 [IL-6] level. This randomized trial was performed in Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China between October 2012 and February 2014. Either regular intermittent bolus [RIB, n=66] or continuous infusion [CI, n=66] was used for epidural labor analgesia. A bolus dose [10 ml of 0.08% ropivacaine + 0.4 microg·ml[-1] sufentanil] was manually administrated once an hour in the RIB group, whereas the same solution was continuously infused at a constant rate of 10 ml·h[-1] in the CI group. Maternal tympanic temperature and serum IL-6 level were measured hourly from baseline to one hour post partum. The incidences of fever [>/= 38°C] were calculated. The incidence of maternal fever was similar between the 2 groups. There was a rising trend in mean temperature over time in both groups, but no statistical difference was detected between the groups at respective time points; maternal serum IL-6 showed similar changes. Compared with continuous infusion, regular intermittent bolus presents with the same incidence of maternal fever for epidural labor analgesia. Interleukin-6 elevation could be involved in mean maternal temperature increase