Predictive Factors of Early Weight Loss after Laparoscopic Sleeve Gastrectomy / 中国医学科学院学报

Objective To explore the clinical factors that can be used to predict the early weight loss after laparoscopic sleeve gastrectomy(LSG).Methods The clinical data of 64 obese patients undergoing LSG in Peking Union Medical College Hospital from August 2015 to January 2018 were retrospectively analyzed.We analyzed the relationship between different clinical factors and early weight loss,determined the independent predictors based on models,and estimated their test power by using the receiver operating characteristic(ROC)curves.Results Correlation analysis indicated that preoperative body mass index(=0.000,=0.000,=0.000),waist circumference(WC)(=0.000,=0.000,=0.000),whole body fat volume(=0.000,=0.006,=0.003),homeostatic model assessment for insulin resistance(HOMA-IR)(=0.000,=0.000,=0.002),and hypersensitive C-reactive protein(hsCRP)(=0.004,=0.002,=0.025)were negatively correlated with excess weight loss percentage(EWL %) after 3,6 and 12 months.Also,hsCRP after 6 months showed negative correlation with EWL % after 1 year(=0.029).Binary Logistic regression analysis showed that WC was an independent predictor of early weight loss(=0.018).ROC analysis showed that when the optimal cutoff value is 142.5 cm for WC, index was highest,with a sensitivity of 80% and a specificity of 87%.Patients were further divided into low WC group and high WC group based on this optimal cutoff value.The low WC group had significantly higher EWL% than the high WC group 3 months(=6.677,=0.000),6 months(=6.157,=0.000),and 1 year(=4.006,=0.000)after surgery.The low WC group also had significantly lower hsCRP than high WC group 6 months after surgery(=-3.510,=0.000).HOMA-IR showed no significant difference between these two groups(=-0.821,=0.412).Conclusions WC is an independent predictor of weight loss early after LSG.The patients with low WC have better weight loss effectiveness.

Impacts of moxibustion at Zusanli (ST 36) on the improvements in the quality of life in patients with advanced malignant tumor / 中国针灸

OBJECTIVE@#To observe the impacts of moxibustion at Zusanli (ST 36) on the improvements in the quality of life in the patients with advanced malignant tumor.@*METHODS@#A total of 60 patients with advanced malignant tumor were randomized into an observation group and a control group, 30 cases in each one. In the control group, the routine symptomatic scheme was adopted. In the observation group, on the base of the routine treatment, moxibustion was applied to bilateral Zusanli (ST 36), once a day. The observation period was 12 days. The percentages of , and in T lymphocyte subset, the ratio of / , the value of hemoglobin, Karnofsky score (KPS) and the main symptom score of traditional Chinese medicine (TCM) were compared before and after treatment in the two groups.@*RESULTS@#In comparison before and after treatment in the two groups as well as between the two groups, the differences were not significant in the contents of , and , hemoglobin and the ratio of / (all >0.05). In the observation group, KPS after treatment was increased as compared with the score before treatment (0.05). In the observation group, the improvements in lassitude, short breath, poor appetite, dizziness and vertigo, complexion, palpitation, soreness and weakness of the lumber region and knee joint as well as the total score were better than the control group (<0.05, <0.01).@*CONCLUSION@#Moxibustion at Zusanli (ST 36) effectively regulates the immune balance and relieves the clinical symptoms in the patients with advanced malignant tumor.

Multidisciplinary Team and Nutrition Management for Bariatric Surgery / 中国医学科学院学报

Bariatric surgery remains the most successful treatment for morbid obesity. Multiple departments may be involved due to the presence of various co-morbidities and the complex procedure. Thus,the establishment of a multidisciplinary team based on endocrinology,gastrointestinal surgery,nutrition,and psychology is important to ensure a successful bariatric surgery. Although the bariatric surgery has definite effectiveness in decreasing body weight and improving comorbidities,patients may still face the risks including protein and/or micronutrient malnutrition and other complications after the bariatric surgery. The medium-and long-term follow-up and nutrition management after bariatric surgery mainly focus on the following two aspects: weight loss and improvement of obesity-related complications; and assessment and treatment of possible nutritional deficiencies and eating disorders.

Effectiveness of Laparoscopic Sleeve Gastrectomy in Treating Obesity and Its Co-morbidities / 中国医学科学院学报

Objective To analyze the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) in treating obesity and its co-morbidities.Methods The clinical data of obese patients undergoing LSG in Peking Union Medical College Hospital from August 2012 to August 2017 were retrospectively analyzed. Medium-term outcome measures included excess weight loss (%EWL),co-morbidity improvement,and complications.Results Seventy-five obese patients comprising 28 men[ body mass index(BMI):(47.3±7.5)kg/m ) ] and 47 women [BMI (41.1±7.0) kg/m ] were enrolled in this analysis. The common co-morbidities were liver dysfunction (53.3%),dyslipidemia (52.0%),obstructive sleep apnea (45.3%),type 2 diabetes mellitus (38.7%),and arterial hypertension (37.3%),which were improved by 75.0%,58.3%,83.3%,75.0% and 58.3% three years after surgery. The mean %EWL at 1,2,and 3 years after surgery was 81.6±34.7,80.9±30.2 and 79.7±30.8,respectively. The proportions of patients achieving successful weight loss were 81.7% (n=49),81.0% (n=34),and 79.3% (n=23) at 1,2,and 3 years (%EWL>50%). Early severe complications (Clavien-Dindo classification>2) occurred in 2.6% of patients,and the most common late complications was gastroesophageal reflux disease,which could be relieved by acid suppressants.Conclusion LSG is effective and safe in treating obesity and its co-morbidities.

Perioperative Evaluation of Obstructive Sleep Apnea in Bariatric Surgery Population / 中国医学科学院学报

Objective To evaluate the prevalence and clinical characteristics of obstructive sleep apnea (OSA) in bariatric surgery population.Methods Consecutive patients undergoing preoperative evaluation for bariatric surgery and referred for sleep monitoring in Peking Union Medical College Hospital from January 2009 to December 2015 were retrospectively analyzed. Age,gender,symptoms of snoring,fatigue,apnea and somnolence,apnea hyponea index (AHI),arterial blood gas,pulmonary function,sleep respiratory monitoring,positive airway therapy of OSA,and postoperative complications were recorded. The clinical characteristics of OSA groups at different severity were compared using AHI≥5 events/hour and AHI≥15 events/hour as cut-off values. Correlation analysis was applied to identify the clinical factors associated with AHI.Results Of 42 patients with complete sleeping monitoring data before bariatric surgery,30(71.4%) were diagnosed as OSA,14 (33.3%) were moderate or severe and 11 (26.2%) were severe. Also,OSA was not detected before the bariatric surgery in 25 cases (83.3%). Compared with patients with AHI<5 events/hour,patients with AHI≥5 events/hour had significantly older age (t=2.869,P=0.007),higher proportion of observed apnea (P=0.035),higher AHI (z=-4.592,P=0.000),higher proportion of night pulse oxygen saturation(SpO) below 90% (z=-2.746,P=0.006),lower mean SpO (t=-2.071,P=0.046) and lower lowest SpO (t=-3.914,P=0.000). Compared with AHI<15 events/hour group,the AHI≥15 events/hour group had significantly higher BMI (t=2.281,P=0.043),male ratio (P=0.005),incidence of hypertension (P=0.011),proportion of observed apnea (P=0.001),percentage of smoking history (P=0.017),partial pressure of carbon dioxide(PaCO)(t=3.478,P=0.002),AHI (z=-4.592,P=0.000),and proportion of night SpO below 90% (z=-4.530,P=0.000); in addition,the forced expiratory volume in one second(FEV1)% predicted (t=-3.377,P=0.002),forced vital capacity(FVC)% predicted (t=-2.342,P=0.026),night time mean SpO (t=-3.392,P=0.007),lowest SpO (t=-5.535,P=0.000) were significantly decreased. Correlation analysis showed that,in populations with normal PaCO (n=36),AHI was positively correlated with age (r=0.450,P=0.006) and BMI (r=0.384,P=0.021) and negatively correlated with FEV1% predicted (r=-0.457,P=0.008) and FVC% predicted (r=-0.432,P=0.013). Partial correlation analysis showed that,after age and BMI were adjusted,AHI was not correlated with FEV1% predicted(r=-0.287,P=0.125)and FVC%predicted(r=-0.241,P=0.200).Conclusion The incidence and underdiagnosis rate of OSA are high in bariatric surgery population. OSA should be routinely screened in bariatric population to reduce the postoperative complication.

Relationship between Depression and Quality of Life in Patients with Severe Obesity / 中国医学科学院学报

Objective To investigate the depression status and quality of life (QoL) of patients with severe obesity who have undergone bariatric surgery and to evaluate their potential correlation.Methods A total of 50 patients with severe obesity who had undergone elective bariatric surgery in the general surgical ward of Peking Union Medical College from January 2013 to December 2017 were enrolled in this study. The general data were collected. The patient's depression status and QoL were assessed by the Zung's Depression Self-Assessment Scale and the SF-36 Quality of Life Scale,respectively.Results The depression score was (44.85±9.07) scores in these 50 patients,including 38 patients (76%) without depression and 12 (24%) with mild depression. The scores of the mental-emotional,physical,psychomotor,and psychological barrier dimensions of patients with severe obesity were (3.70±1.25),(18.65±4.10),(4.25±1.35),and (18.75±5.46)scores,respectively. The physiological function score of patients with mild depression was (95.83±10.21)scores,which was significantly higher than those without depression (68.42±38.95) scores(F=6.209,P=0.011). The vitality and mental health scores were (46.67±14.72) and (57.33±14.68) scores in patients with mild depression,which were significantly lower than those [(65.79±21.94) (F=4.867,P=0.030) and (75.16±17.21) scores (F=0.212,P=0.032)] in patients without depression. Correlation analysis showed that the mental-emotional score was positively correlated with physical score in patients with severe obesity (r=0.503,P=0.015),whereas the depression score was negatively correlated with the general health status (r=-0.430,P=0.032),vitality (r=-0.594,P=0.002),social functioning (r=-0.455,P=0.022),mental health (r=-0.562,P=0.003),and QoL score (r=-0.439,P=0.028).Conclusions The QoL is remarkably affected by depression in patients with severe obesity before surgery. Assessment of the mental status of patients with severe obesity may help to identify this problem and thus improve the QoL.

Effect of Neoadjuvant Chemotherapy Treatment on Prognosis of Patients with Advanced Gastric Cancer: a Retrospective Study / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the prognostic effects of neoadjuvant chemotherapy (NAC) in patients with local advanced gastric cancer.</p><p><b>METHODS</b>We retrospectively analyzed prognosis in 191 patients with advanced gastric cancer, of whom 71 were treated with NAC and 120 received surgery only between February 2007 and July 2013. Postoperative complication rate was recorded. Survival by clinicopathological features, pathological T and N stages, and histopathological tumor regression was retrospectively compared between the two groups.</p><p><b>RESULTS</b>According to Response Evaluation Criteria in Solid Tumors, none of the 71 patients in the NAC followed by surgery group showed complete response, 36 showed partial response, 25 had stable disease, and 10 had progressive disease. The chemotherapy response rate was 50.7%; the disease control rate was 85.9%. Grade 3/4 adverse events were seen in less than 20% patients, with acceptable toxicities. No difference was found in the overall postoperative complication rates between the two groups (7 versus 22 cases, P=0.18). Median survival time was significantly different, at 54 months in the NAC combined with surgery group and 25 months in the surgery-only group (P=0.025).</p><p><b>CONCLUSION</b>In patients with operable gastric adenocarcinomas, NAC can significantly improve overall survival without increasing surgical complications.</p>

Values of iodine metabolism biomarkers in assessing the iodine nutrition status in surgically treated patients with thyroid disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the clinical application value of iodine metabolism biomarkers in assessing iodine nutrition status in surgically treated patients with thyroid disease.</p><p><b>METHODS</b>Blood,morning urine and 24-hour urine samples were collected in 31 healthy volunteers and in 30 surgically treated patients with thyroid disease before and after surgery. Iodine concentration was analyzed by inductively coupled plasma mass spectrometry. The iodine metabolism biomarkers including serum iodine (SI), morning urine iodine(UI), morning urine iodine/urine creatinine ratio (UI/UCr), 24-hour urine iodine (24 h UI), and 24-hour urine iodine excretion (24 h UIE) were evaluated in these two groups. In addition, the validation coincidence rate of iodine metabolism biomarkers in healthy volunteers to different reference ranges including World Health Organization, Mayo Clinic, and Quest Diagnostics were calculated.</p><p><b>RESULTS</b>The UI/UCr ratio of pre-operative thyroid disease patients was significantly lower than that of healthy volunteers (P<0.05), while the other biomarkers showed no significant differences (all P>0.05) between these two groups. The SI, UI ,and 24 h UI in postoperative thyroid disease patients were significantly higher than those of the pre-operative patients (all P<0.05). Though the medians of all biomarkers in healthy volunteers were within the reference ranges,only the validation coincidence rates of SI, UI, and UI/UCr in the 41-70-year populations were over than 90% according to Mayo Clinic; furthermore, the area under the receiver operating characteristic curve about UI/UCr ratio (0.737) was the biggest within the iodine metabolism biomarkers.</p><p><b>CONCLUSION</b>The UI/UCr ratio may be used for iodine nutrition evaluation in surgically treated patients with thyroid disease.</p>

Surgical Diagnosis and Treatment of Primary Hyperthyroidism Complicated with Occult Thyroid Carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the surgical diagnosis and treatment of primary hyperthyroidism complicated with occult thyroid carcinoma.</p><p><b>METHOD</b>Data of 51 cases of primary hyperthyroidism complicated with occult thyroid carcinoma admitted during January 2004 to November 2014 were analyzed retrospectively.</p><p><b>RESULTS</b>The incidence of occult thyroid carcinoma was 5.03% in hyperthyroidism,and 47 cases (92.16%) were female. The preoperative diagnosis of all these 51 cases was primary hyperthyroidism and 11 cases were diagnosed thyroid carcinoma at the same time;25 cases were diagnosed thyroid carcinoma by frozen section and the remaining 26 cases were diagnosed by postoperative pathology. Finally,26 cases underwent subtotal thyroidectomy,4 cases underwent total thyroidectomy, and 21 cases underwent total thyroidectomy with lymphadenectomy. The tumor size ranged from 0.1 to 1.0 cm [mean:(0.63 ± 0.35) cm]. The lesions were less than or equal to 0.5 cm in 28 cases (54.9%). The follow-up lasted from 1 to 121 months [mean:(28.6 ± 22.7)months] in 43 patients,and all of them survived.</p><p><b>CONCLUSIONS</b>Primary hyperthyroidism complicated with occult thyroid carcinoma is commonly found in female patients. Preoperative diagnosis is difficult. Ultrasound is the major examining method. Frozen section can increase the detection rate. The postoperative prognosis of hyperthyroidism complicated with occult thyroid carcinoma is satisfactory.</p>

Research progress on the effects of acupuncture-moxibustion serum / 中国针灸

The acupuncture-moxibustion serum has received wide attention as a new idea and method. Its application on researches in vivo and the treatment of disease not only has an important theory value, but also provides new ideas for overcoming the limitations of researches in vivo and some disease's treatment. Literature regarding the basic research of acupuncture-moxibustion serum for last more than 10 years is reviewed, and the effects of acupuncture-moxibustion serum on respiratory system, digestive system, cardiovascular system, nervous system, immune system, anti-aging, bone metabolism and anti-cancer are summarized, hoping to provide references for clinical treatment and evidence-based medicine.

MicroRNA and gastric cancer / 中国医学科学院学报

Gastric cancer is caused by the interaction of genetic and environmental factors. MicroRNA (miRNA) is involved in many cellular processes including proliferation, differentiation, and apoptosis and plays an important role in pathogenesis of gastric cancer, as demonstrated in many recent studies from perspectives including miRNA profiling, reciprocal modulation between epigenetic and miRNA, and Helicobacter pylori infection. MiRNA is highly stabe in blood, and therefore non-invasive diagnosis of gastric cancer using circulating miRNA may be promising.

Effects of eukaryotic translation initiation factor 5A2 down-regulation by small interfering RNA on aggressiveness of MKN28 human / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effects of eukaryotic translation initiation factor 5A2 (EIF5A2) down-regulation by small interfering RNA (siRNA) on aggressiveness of human gastric cancer cell and its potential mechanisms.</p><p><b>METHODS</b>The expressions of EIF5A2 in human gastric cancer cell lines (MKN28 and HGC27) and immortalized gastric mucosal epithelial cells (GES-1) were measured by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blotting. EIF5A2 gene in MKN28 cells was silenced by RNA interference and the inhibitory effect was evaluated by both qRT-PCR and Western blotting. Cell proliferation was assessed by CCK-8 assay. Cell migration and invasion were assessed by Transwell assay. The possible downstream targets of EIF5A2, such as CyclinD1, CyclinD3, matrix metallopeptidase-9 (MMP-9), E-cadherin, vimintin, C-myc, and metastasis-associated protein 1 (MTA1) expression levels, were examined by Western blotting.</p><p><b>RESULTS</b>High expressions of EIF5A2 were found in MKN28 cells and human gastric adenocarcinoma tissues. Both EIF5A2 mRNA and protein expression in MKN28 cells were significantly down-regulated by siRNA#1 and siRNA#2, especially siRNA#1. Knockdown of EIF5A2 caused an apparent suppression of MKN28 cell proliferation (all P<0.01), migration (P<0.001), and invasion (P<0.001). After the knockdown of EIF5A2 in MKN28 cells, E-cadherin levels were upregulated, whereas vimentin, Cyclin D1, Cyclin D3, C-myc and MTA1 levels were downregulated.</p><p><b>CONCLUSION</b>Knockdown of EIF5A2 may inhibit MKN28 cell proliferation by downregulating the CyclinD1 and CyclinD3 and suppressing the cell migration and invasion by inhibiting MTA1, C-myc and epithelial-mesenchymal transition.</p>

Effect of n-3 polyunsaturated fatty acids on gut microbiota and endotoxin levels in portal vein of rats fed with high-fat diet / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effect of n-3 polyunsaturated fatty acids (n-3PUFAs) on gut microbiota and endotoxin levels in portal vein of rats fed with a high-fat diet (HFD).</p><p><b>METHODS</b>Thirty-six male Sprague-Dawley rats were randomly divided into four groups and fed with normal control diet (CD), HFD, CD supplemented with n-3PUFAs, and HFD supplemented with n-3PUFAs, respectively. Fresh fecal samples were collected to analyze the gut microbiota 10 weeks after feeding. DNA was exacted from the fresh fecal samples. Quantitative PCR was used to detect the composition of the gut microbiota. The endotoxin levels were detected through modified azo chromogenic substrate limulus amebocyte lysate assay.</p><p><b>RESULTS</b>The differences in body weight before breeding in each group were not statistically significant among these four groups (P=0.613). The increase in the body weight was significantly larger in the HFD group than in the CD group (P=0.0002), CD+n-3PUFAs group (P=0.0001), and HFD+n-3PUFAs group (P=0.022). There were significantly more firmicutes (P=0.002) and enterobacteriales (P=0.022) and significantly less bacteroidetes (P=0.026) and bifidobactera (P=0.034) in the gut of rats from HFD group than those from the CD group. There were significantly more bacteroidetes in the fecal samples of the rats from the CD+n-3PUFAs group compared to those from the CD group (P=0.043). There were significantly more firmicutes (P=0.044)and enterobacteriales (P=0.012) and less bacteroidetes (P=0.042) in the fecal samples of the rats from HFD group compared to those from the HFD+n-3PUFAs group. The endotoxin in plasma form portal vein of rats in HFD group were significantly higher than in CD group (P=0.007) and HFD+n-3PUFAs group (P=0.042) but showed no significant difference between CD+n-3PUFAs and CD group (P=0.210).</p><p><b>CONCLUSIONS</b>HFD can increase body weight and change gut microbiota. Supplementation of n-3PUFAs can partially counteract such gut dysbiosis, lower endotoxin level in portal vein blood, and improve the body weight.</p>

Clinical research of primary trigeminal neuralgia treated with electroacupuncture at qi streets acupoints combined with spinal regulation therapy / 中国针灸

<p><b>OBJECTIVE</b>To compare the difference in the clinical efficacy on primary trigeminal neuralgia (PTN) between the comprehensive therapy of electroacupuncture (EA) at qi streets acupoints combined with spinal regulation method and medication with carbamazepine (CBZ).</p><p><b>METHODS</b>Sixty patients were randomized into a comprehensive therapy group (30 cases) and a medication group (30 cases). In the comprehensive therapy group, the acupoints at qi streets on the head such as Taiyang (EX-HN 5) and Sishencong (EX-HN 1) and those at qi streets on the chest and abdomen such as Shenshu (BL 23), Zhongwan (CV 12) and Guanyuan (CV 4), etc. were selected. After arrival of qi, EA was attached on 2 to 4 groups of acupoints. After acupuncture, the spinal regulation method was applied. This comprehensive therapy was given once a day. In the medication group, CBZ was used for oral administration, 100 mg at the first time, twice a day, and 400 to 600 mg each day as the maintenance dose. Separately, before and after treatment, in 2 and 6 months in follow-up, pain rating index (PRI), life satisfaction index B (LSI-B) and hamilton depression scale (HAMD) were adopted to evaluate comprehensively the clinical efficacy in the two groups and compare the adverse reaction during the treatment between the two groups.</p><p><b>RESULTS</b>After treatment, the curative and markedly effective rate in the comprehensive therapy group was 76.7% (23/30), which was better than 63.3% (19/30) in the medication group (P < 0.01). The difference in PRI was not significant after treatment between the two groups (all P > 0.05). In 2 and 6 months follow-up, PRI grade in the comprehensive therapy group was superior to that of the medication group (both P<0. 05). After treatment and in follow-up, HAMD score was all reduced in the two groups (P < 0.01, P < 0.05) and the result in follow-up in the comprehensive therapy group was significant as compared with that in the medication group (all P<0. 05). After treatment, LSI-B score was increased obviously in the two groups (all P < 0.05) and the result in the comprehensive therapy group was better than that in the medication group (P < 0.05). The incidence of adverse reaction in the comprehensive therapy group was 16.7% (5/30), which was lower than 30.0% (9/30, P < 0.01) in the medication group.</p><p><b>CONCLUSION</b>The comprehensive therapy of EA at qi streets acpoints combined with spinal regulation method achieves the long-term efficacy on PTN as compared with oral administration of CBZ in terms of the improvement of psychological condition, analgesia and life quality. It is the safe, effective and stable therapy.</p>

Clinical research of electroacupuncture at acupoints of qijie area combined with spine balance-regulating massage on posterior circulation ischemia / 中国针灸

<p><b>OBJECTIVE</b>To compare the clinical efficacy difference between electroacupuncture (EA) at qijie area combined with spine balance-regulating massage and medication for posterior circulation ischemia (PCI).</p><p><b>METHODS</b>One hundred cases of PCI were randomly divided into a treatment group (50 cases) and a medication group (50 cases). The treatment group was treated with EA at Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Shenshu (BL 23), Danzhong (CV 17), etc. in qijie area combined with spine muscle-relieving massage and comprehensive chiropractic. The medication group was treated with oral administration of nimodipine (30 mg per time, three treatments per day) and vinpocetine injection with 500 mL of glucose injection or intravenous drip of 500 mL 0.9% sodium chloride injection, once a day. Ten treatments were taken as one course in both groups, and two courses were given. The symptom score, mean resistance index (RI) of vertebral artery (VA) and basilar artery (BA), mean velocity of blood flow (Vm) and comprehensive clinical efficacy were compared before and after treatment in two groups.</p><p><b>RESULTS</b>The cured and markedly effective rate was 79.6% (39/49) in the treatment group, which was superior to 54.7% (23/42) in the medication group (P<0.05). The symptom score was both significantly improved after treatment in two groups (both P<0.05), which was more obvious in the treatment group (P<0.05). The RI of VA and BA, Vm of VA and BA were significantly improved after treatment in two groups (all P<0.05), which were more obvious in the treatment group (all P<0.05).</p><p><b>CONCLUSION</b>The electroacupuncture combined with spine balance-regulating massage has superior effect on improving mean velocity of blood flow and resistance index of vertebral artery and basilar artery as well as symptom score to medication, and is believed to be a safe and effective treatment for posterior circulation ischemia.</p>

Benefits of intra-operative systemic chemotherapy during curative surgery in patients with locally advanced gastric cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is little information on the impact of intra-operative systemic chemotherapy on gastric cancer. The aim of this study was to identify prognostic factors in patients with locally advanced gastric cancer and undergoing curative resection, with a focus on evaluating survival benefits and tolerance of intra-operative systemic chemotherapy.</p><p><b>METHODS</b>We retrospectively analyzed clinicopathological data for 264 consecutive patients who underwent curative resection for gastric cancer at Peking Union Medical College Hospital from January 2002 to January 2007. Survival curves were plotted using the Kaplan-Meier method and compared using log-rank tests. Univariate and multivariate analyses were performed with the Cox proportional hazard model.</p><p><b>RESULTS</b>Patients who received intra-operative systemic chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P = 0.019 and 0.010, respectively) than patients who did not receive intra-operative systemic chemotherapy. In the subgroup analysis, systemic intra-operative chemotherapy benefited the 5-year overall survival and disease-free survival rates for patients with cancer of stage pTNM IB-IIIB, but not stage pTNM IIIC. Patients who received intra-operative systemic chemotherapy in combination with post-operative chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P = 0.046 and 0.021, respectively) than patients who only received postoperative chemotherapy. However, the difference in these rates between patients who received only intra-operative systemic chemotherapy and patients who only received curative surgery was not statistically significant (P = 0.150 and 0.170, respectively). Multivariate analyses showed that intra-operative systemic chemotherapy was a favorable prognostic factor for the overall survival and disease-free survival rates (P = 0.048 and 0.023, respectively). No grade 4 toxicities related to intra-operative systemic chemotherapy were recorded within the 4 weeks after surgery.</p><p><b>CONCLUSION</b>Intra-operative systemic chemotherapy during curative surgery may benefit patients with stage pTNM IBIIIB gastric cancer in terms of both overall survival and disease-free survival.</p>

Lumbar disc herniation treated with qi pathway intervention and spinal adjustment: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the efficacy difference in the treatment of lumbar disc herniation (LDH) between the comprehensive therapy of qi pathway intervention and the spinal adjustment and the conventional therapy of acupuncture and Tuina and explore the analgesic mechanism.</p><p><b>METHODS</b>Seventy-one cases were randomized into a comprehensive therapy group (36 cases) and a conventional therapy group (35 cases). In the comprehensive therapy group, the acupoints in the region of abdominal qi pathway were selected and stimulated manually with both hands. In combination, the spinal adjustment therapy was applied. In the conventional therapy group, Shenshu (BL 23), Dachangshu (BL 25), Huantiao (GB 30) and Chengfu (BL 36) on the affected side were selected and stimulated with the conventional needling technique. Additionally, the routine Tuina therapy was applied. Before and after treatment, the visual analogue scale (VAS), Oswestry disability index (ODI) questionnaire, the health related quality of life (SF-36) questionnaire and the level of serum tumor necrosis factor (TNF-alpha) were adopted to determine analgesic effect and clinical efficacy.</p><p><b>RESULTS</b>In the comprehensive therapy group, the curative and effective rate was 91.7% (33/36), which was apparently superior to 77.1% (27/35) in the conventional therapy group (P < 0.05). The analgesic effect in the first 10 treatments in the comprehensive therapy group was apparently superior to that in the conventional therapy group (P < 0.05). ODI after treatment was improved significantly in both groups (both P < 0.05), in which the result in the comprehensive therapy group was superior to that in the conventional therapy group (P < 0.05). After treatment, the SF-36 values of gener al health, bodily pain, physiological functioning, social functioning and emotional functioning in the comprehensive therapy group were superior to that in the conventional therapy group (all P < 0.05). After 15 treatments, the level of serum TNF-alpha in the comprehensive therapy group was lowered as compared with that before treatment and lower apparently than that in the conventional therapy group (P < 0.05); after 30 treatments, it was also lower than that in conventional therapy group (P < 0.05).</p><p><b>CONCLUSION</b>In the guide of the theory of qi pathway, the comprehensive therapy of acupuncture and spinal adjustment intervention achieves the quick and good efficacy on LDH as compared with the conventional acupuncture and Tuina and improves the quality of life for the patients to certain extent. The analgesic effect of this therapy is relevant with the decrease of serum TNF-alpha.</p>

Treatment of cervical spondylosis by spinal balancing combined with intervention of pathway of qi: a randomized controlled study / 中国针灸

<p><b>OBJECTIVE</b>To compare the difference in the efficacy of cervical spondylosis between the combined therapy of spinal balancing and the intervention of pathway of qi and the conventional acupuncture and massage therapy.</p><p><b>METHODS</b>Two hundred and seventy-four cases of cervical spondylosis were randomized into a spinal balancing group and a conventional acupuncture group, 137 cases in each one. In the spinal balancing group, the points on the pathway of qi on the head and on the abdomen were selected [the pathway of qi on the head: Baihui (GV 20), Tianzhu (BL 10), Wangu (GB 12) and the others; the pathway of qi on the abdomen: Shenshu (BL 23), Guanyuan (CV 4), Zhongji (CV 3) and the others]. The bimanual needling technique was applied in combination with spinal balancing therapy. In the conventional acupuncture group, the points were Jiaji (EX-B 2) (C3-C7), Fengchi (GB 20), Wangu (GB 12), Baihui (GV 20), etc. The conventional acupuncture technique and massage therapy were adopted. The neck pain questionnaire (NPQ) was adopted to assess the clinical efficacy of the two groups before and after treatment.</p><p><b>RESULTS</b>NPQ score was all improved significantly after treatment in the two groups (all P < 0.05). The result in the spinal balancing group was superior to the conventional acupuncture group (P < 0.05). The curative and effective rate was 83.2% (114/137) in the spinal balancing group, which was better than 69.3% (95/137) in the conventional acupuncture group (P < 0.05). In terms of the types of cervical spondylosis, from high to low, the efficacy sequence was cervical type, nerve root type, vertebral artery type, sympathetic nerve type and spinal cord type.</p><p><b>CONCLUSION</b>The combined therapy of spinal balancing and the intervention of pathway of qi achieves the superior efficacy on various types of cervical spondylosis as compared with the conventional acupuncture and massage therapy. It apparently relieves the symptoms and improves the life quality of the patients.</p>

Effect of enteral nutrition via jejunostomy catheter on quality of life in gastric cancer patients who have undergone gastrectomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the effect of enteral nutrition via jejunostomy catheter on the quality of life in gastric cancer patients who have undergone gastrectomy.</p><p><b>METHODS</b>We retrospectively analyzed clinical data of 104 consecutive patients who had undergone curative resection for gastric cancer in Peking Union Medical College Hospital in 2011.All data were obtained from a prospectively maintained database of gastric cancer.The quality of life was compared between jejunostomy tube group(n=49)and tube-free group(n=55).</p><p><b>RESULTS</b>The two groups were matched in gender,age,tumor size,tumor location,histological type,pTNM stage,type of surgery,body mass index(BMI),quality of life scales,and cycles of postoperative adjuvant chemotherapy(all P>0.05).Also,the global health status(P=0.154),physical function score(P=0.321),role function score(P=0.492),and fatigue symptom score(P=0.845)were not significantly different between these two groups one month after surgery.Three and 6 months after the surgery,patients in the jejunostomy tube group had significantly higher overall health status scores( P<0.001,P=0.038),physical function scores(P=0.004,P=0.005),and role function scores(P=0.002,P=0.038)and significantly lower fatigue symptom scores(P=0.020,P=0.043)when compared to patients from tube-free group.</p><p><b>CONCLUSION</b>Enteral nutrition via jejunostomy catheter can improve the quality of life of gastric cancer patients who have undergone gastrectomy.</p>

Iodine nutrition and thyroid diseases / 中国医学科学院学报

Iodine, an essential component of the hormones produced by the thyroid gland, is widely but unevenly distributed in the earth's environment. Great difference exists in the iodine nutritional status of populations residing in different region. Both iodine deficiency and iodine excess can injure the thyroid gland. Iodine deficiency tigers endemic goiter, cretinism, and hyperthyroidism, while iodine excess can result in high iodine goiter, chronic lymphocytic thyroiditis, iodine-induced hyperthyroidism, and hypothyroidism; also, iodine deficiency or excess may affect the histological type of thyroid cancer. In 1996, China began to implement the universal salt iodization policy, which has basically eliminated the iodine deficiency disorders nationwide; however, it also caused the changes in the spectra of other thyroid diseases including iodine-induced hyperthyroidism, autoimmune thyroid disease, and papillary thyroid carcinoma. Individualized iodine nutritional status assessment for the populations, particularly those with thyroid diseases, will be beneficial.