Association of community built environment with obesity among elderly residents / 环境与职业医学

Background In the context of improving urban environment for healthy aging, it is necessary to rationally plan and provide community living space and public service facilities suitable for the elderly, and constantly optimize the built environment towards an age-friendly city. Objective To understand the relationship between community built environment and obesity in the elderly in Longgang City, and to provide a reference basis for improving the health of the elderly. Methods Elderly adults aged 60-90 years (n=6527) who completed a physical examination during the period from October 2020 to January 2021 in Longgang City were surveyed, and data on height and weight, waist circumference (WC), and other sociological demographic characteristics were obtained. Overweight was determined by 24 kg·m−2 ≤ body mass index (BMI) < 28 kg·m−2 and obesity by BMI ≥ 28 kg·m−2. Men with WC ≥ 85 cm and women with WC ≥ 80 cm were considered central obesity. Based on the participants' residential addresses, geocoding was performed using a geographic information system, and built environment indicators such as restaurants, convenience stores, and basic medical facilities were obtained using Gaode Map. A binary logistic regression model with adjusted individual-level covariates was used to evaluate the relationship between obesity and built environment indicators among elderly adults by gender and age. Results Among the 6527 community elderly, 46.93% were male and 53.07% were female, with a mean age of (73.69±0.07) years, a mean BMI of (24.32±2.84) kg·m−2, and 51.92% of the elderly were overweight or obese. The regression results showed that for elderly men, the more convenience stores and the higher mixed land use in residential areas, the higher risk of central obesity; however, the increases in street connectivity and accessibility to parks and recreational areas were associated a decreased risk of central obesity. The prevalence of overweight/obesity was higher among elderly women with more convenience stores in residential areas, while increased street connectivity was associated with a lower prevalence of central obesity among elderly women. Accessibility to primary health care facilities was negatively associated with the risk of central obesity among the 60- to 70-year-olds. For elderly residents aged 71−80 years, higher mixed land use and better accessibility to transit stations were associated with a higher prevalence of overweight/obesity, while street connectivity was negatively associated with the central obesity. Proximity to parks and recreational areas was associated with a reduced risk of overweight/obesity among the 81- to 90-year-olds. Conclusion Among the variables of a 500-m neighborhood built environment, the number of convenience stores, mixed land use, street connectivity, accessibility to primary health care facilities, accessibility to public transit stations, and accessibility to parks and recreational areas are correlated with obesity among elderly residents, and the degree of influence varies by gender and age.

Research progress in atezolizumab in the treatment of lung cancer / 中国胸心血管外科临床杂志

@#In recent years, atezolizumab, a programmed death-ligand 1 (PD-L1) has shown clinical efficacies against many different solid malignancies. In late October 2016, the Food and Drug Administration (FDA) granted approval to atezolizumab for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) who have disease progression during or following platinum-containing chemotherapy. With the development of clinical trials, the applications of atezolizumab in lung cancer treatment have gradually expanded. In this review, we summarized the current clinical status of atezolizumab in the treatment of lung cancer.

The serum metabolomic profile in elderly overweight patients with metabolic syndrome / 中华老年医学杂志

Objective:To examine differences in metabolic characteristics and metabolites between elderly overweight patients with metabolic syndrome and healthy elderly people, and to identify related factors.Methods:A group of 36 MS patients(the MS group)admitted to The Fourth Central Hospital of Tianjin from April to August 2018 and 43 elderly people(the control group)who underwent physical examination during the same period were included in this prospective study.Serum samples of the patients with metabolic syndrome and elderly healthy controls were collected, and ultra-performance liquid chromatography and quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS)based non-targeted metabolomics was used to search for differences in metabolites between the serum samples of the two groups.The Pearson correlation statistical method was used to find related clinical factors.Results:Comparison of baseline data of the enrolled participants showed that there were statistically significant differences between the two groups in body mass index[(26.9±2.0)kg/m 2vs.(21.7±1.4)kg/m 2], waist circumference, systolic blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol( P<0.01). Metabolomics results showed that there were differences in 65 serum metabolites between elderly overweight patients with metabolic syndrome and elderly normal controls, and these differences were enriched in 21 pathways.Correlation analysis showed that waist circumference had the largest number of differential metabolites, followed by body mass index.The major differential metabolites were monosaccharides such as mannose, lyxose and glucose, linolenic acid and its derivatives, and pyroglutamate. Conclusions:Compared with normal elderly people, elderly patients with overweight metabolic syndrome have a variety of differential metabolites, and these metabolites are highly correlated with clinical indicators related to overweight, such as body mass index and waist circumference, and they include monosaccharides, linolenic acid derivatives and amino acids.

Hyperbaric oxygen therapy can effectively treat diabetic foot wounds / 中华物理医学与康复杂志

Objective:To observe the effect of supplementing vacuum sealing drainage with hyperbaric oxygen in the short term treatment of diabetic foot ulcers.Methods:A total of 156 persons diagnosed with diabetic foot ulcers were randomly divided into a control group and a treatment group, each of 78. Both groups received life guidance and active treatment to lower blood sugar and lipids, as well as anti-infection treatment guided by bacterial cultures. Both groups′ wounds were debrided. The wound was then covered with foam, sealed, and negative pressure of -75 to -100mmHg was applied during 1 week of drainage. Two courses of this treatment were applied. In addition, the treatment group received hyperbaric oxygen daily during the two weeks. The exposure pressure was incrased to 0.25MPa over 15min with 100% oxygen. That was inhaled in two 30min sessions with a 10min interval. The pressure then decompressed at a constant rate for 25 minutes. Wound healing, hemorheology, wound granulation tissue staining and any changes in TGF-β1 were observed before as well as after 7 and 14 days of the treatment.Results:The average wound size and symptom score of both groups had improved significantly after the treatment, with the largest effect in the treatment group during the first week. Both groups′ hemorheology had improved significantly after one week, but the treatment group′s improvement was greater. After 2 weeks, however, there was no significant difference in the average hemorheologic indicators for either group compared with before the treatment. Hematoxylin-eosin staining of the wound tissues showed that there were many inflamed cells before the treatment, with relatively little fresh granulation tissue or new blood vessels. After one week of treatment much new granulation tissue was observed under the microscope in both groups, with no significant difference between them. One week later, there was still much granulation tissue in the control group, but slightly less in the treatment group. The ave-rage post-treatment TGF-β1 protein levels in the wound tissues of both groups were significantly higher than before the treatment, but after two weeks the average TGF-β1 protein level had decreased significantly in the treatment group compared with the control group.Conclusions:One week of hyperbaric oxygen treatment can effectively improve the hemorheology of persons with diabetic foot ulcers, promote the proliferation of granulation tissue and fibroblasts, and increase the level of TGF-β1 protein in the wound tissues. However, the effects of hyperbaric oxygen treatment weaken gradually with time.

Prognosis of new-onset left bundle branch block after transcatheter aortic valve replacement in patients with aortic stenosis: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To systematically review the clinical outcome of patients with new-onset left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Methods    Electronic search was performed in PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wanfang and CBM databases to identify studies about the new-onset LBBB after TAVR from inception to March 19, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software. Results    A total of 17 cohort studies were included, covering 9 205 patients, including 2 202 patients with new-onset LBBB and 7 003 without new-onset LBBB after TAVR. The results of meta-analysis showed that patients with new-onset LBBB after TAVR at 30-day (RR=1.65, 95%CI 1.30 to 2.10, P<0.001) and 1-year (RR=1.30, 95%CI 1.16 to 1.45, P<0.001) all-cause mortality was higher than no new-onset LBBB group. One-year cardiovascular mortality was higher in the new-onset LBBB group (RR=1.47, 95%CI 1.21 to 1.79, P<0.001). In the occurrence of 30-day (RR=1.51, 95%CI 1.10 to 2.08, P=0.011) and 1-year (RR=1.34, 95%CI 1.14 to 1.58, P=0.001) rehospitalization rate, 30-day (RR=3.05, 95% CI 1.49 to   6.22, P=0.002) and 1-year (RR=2.15, 95%CI 1.52 to 3.03, P<0.001) pacemaker implantation, the incidence of patients with new-onset LBBB was higher than that of the no new-onset LBBB group. Conclusion    Compared with the patients without LBBB after TAVR, the clinical prognosis of patients with new-onset LBBB after TAVR is poor. In the future, the management and follow-up of the patients with LBBB after TAVR should be further strengthened to improve the prognosis of patients.

Clinical application of laparoscopic splenectomy combined with devascularization in megalosplenia and portal hypertension / 国际外科学杂志

Objective:To investigate the clinical application and efficacy of laparoscopic splenectomy combined with disconnection in megalosplenia and portal hypertension.Methods:The clinical data of 58 patients with splenomegaly of portal hypertension treated in the Department of Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Eastern Hubei Medical Group from January 2016 to January 2020 were analyzed retrospectively, they were divided into laparoscopy group ( n=34) and laparotomy group ( n=24), Laparoscopic splenectomy combined with devascularization was performed in the laparoscopic group, and open splenectomy combined with devascularization was performed in the open group.The general data, operation time, intraoperative bleeding, postoperative exhaust time, postoperative hospital stay and the incidence of postoperative complications (abdominal bleeding, B/C pancreatic leakage, abdominal infection, etc.) were compared between the two groups. The measurement data obeying normal distribution was expressed by mean±standard deviation ( Mean± SD), and the t test was used comparison between groups, and the chi-square test or Fisher exact probability was used comparison between enumeration data. Results:The surgery was successful in both two groups. 2 cases in the laparoscopic group were converted to laparotomy, There was no death in perioperative period.The operation time of laparoscopy group was (205.3±28.6) min and that of laparotomy group was (156.4±20.7) min, which was significantly longer than that of laparotomy group ( P=0.012). The intraoperative bleeding volume of laparotomy group was (327.2±39.5) mL, which was significantly higher than that of laparoscopy group (246.5±32.3) mL. there was significant difference between the two groups ( P<0.05). The postoperative exhaust time and postoperative hospital stay in the laparoscopic group were (2.6±1.4) d and (9.7±2.3) d, the laparotomy group were (3.8±1.5) d and (12.9±2.7) d respectively. The laparoscopy group was shorter than the laparotomy group. The difference between the two groups was statistically significant ( P<0.05). There were 0 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 3 cases of abdominal infection in the laparoscopic group, 1 case of abdominal bleeding, 2 cases of B/C pancreatic leakage and 5 cases of abdominal infection in the open group. The incidence of postoperative complications in the laparoscopic group was lower than that in the open group, but there was no significant difference between the two groups( χ2=2.807, P=0.088). Conclusions:Laparoscopic splenectomy combined with devasculation is safe and feasible, with advantages such as little trauma, quick recovery of postoperative intestinal function and short hospital stay, which benefit patients. However, the operation is difficult and requires high technical and psychological quality of surgeons.

Analysis of Proliferation Characters of Bone Marrow Mesenchymal Stem Cells Derived from Patients with Myelodysplastic Syndrome / 中国实验血液学杂志

OBJECTIVE@#To analyze the proliferation potential of bone marrow-derived mesenchymal stem cells (MSC) in patients with myelodysplastic syndrome (MDS).@*METHODS@#The MSC derived from the 24 patients with newly diagnosed MDS (MDS-MSC group) and MSC derived from 15 patients with nutritional anemia (control group) in the Affiliated Hospital of Hebei University were used as the research objects. The proliferation potential of MSC was analyzed by colony-forming unit assay, doubling time, cumulative passaging, cell number after 10 days of culture with equal amount of MSC and MTT experiment. The mechanism of abnormal proliferation was analyzed by cell cycle experiment, apoptosis experiment and p21 gene expression assay.@*RESULTS@#In the colony forming unit assay, the number of MDS-MSC colonies was 4.44±2.51, which was significantly lower than that of the control group (12.44±2.55)(P<0.01); the doubling time of MDS-MSC group was significantly longer than that of the control group (7.80±3.26 vs 3.63±0.85) (P<0.01); the number of MDS-MSC in 5×10@*CONCLUSION@#The proliferative capability of MDS-MSC is significantly reduced, which relates with the arrest of cell cycle in G

Clinical efficacy of transcatheter aortic valve replacement in elderly patients with aortic stenosis: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To compare the complications of transcatheter aortic valve replacement (TAVR) between aortic valve stenosis (AS) patients ≥90 years and patients <90 years, and to explore the efficacy and safety of TAVR in AS patients ≥90 years. Methods    Databases including PubMed, The Cochrane Library, EMbase, Medline, CNKI, Wanfang Data and China Biology Medicine disc (CBMdisc) were searched by computer from inception to May 2019. Two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. RevMan 5.3 and Stata 15.0 were used for meta-analysis. Results    A total of 12 cohort studies were included, including 60 186 patients (11 350 patients ≥90 years and 48 836 patients <90 years). Meta-analysis showed that compared with the patients <90 years, those ≥90 years had higher all-cause mortality in the hospital (OR=1.51, 95%CI 1.37 to 1.66, P<0.000 01), on postoperative 30 d (OR=1.68, 95%CI 1.50 to 1.89, P<0.000 01) and at postoperative 1 year (OR=1.36, 95%CI 1.25 to 1.48, P<0.000 01), and had higher incidence of stroke (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01), bleeding events (OR=1.14, 95%CI 1.07 to 1.20, P<0.000 01) and vascular complications (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01). Conclusion    All-cause mortality and the incidence of some complications after TAVR in AS patients ≥90 years are higher than those in patients <90 years, but this difference is clinically acceptable. Therefore, TAVR treatment is safe and  effective for elderly patients.

Comparison on efficacy and safety of different bridging anticoagulation therapies in patients undergoing mechanical heart valve replacement surgery / 中华心血管病杂志

Objective@#To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery.@*Methods@#Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies.@*Results@#A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events.@*Conclusion@#LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.

Comparison on efficacy and safety of different bridging anticoagulation therapies in patients undergoing mechanical heart valve replacement surgery / 中华心血管病杂志

Objective: To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery. Methods: Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies. Results: A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events. Conclusion: LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.

Comparing clinical outcomes between bicuspid and tricuspid aortic valve stenosis after transcatheter aortic valve replacement: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical outcomes of bicuspid aortic valve stenosis (BAV) and tricuspid aortic valve stenosis (TAV) after transcatheter aortic valve replacement (TAVR). Methods    A computer-based search in PubMed, EMbase, The Cochrane Library, CBM, CNKI and Wanfang databases from their date of inception to March 2019 was conducted. Two reviewers independently screened the articles, extracted data and evaluated their quality. RevMan 5.3 and Stata 15.0 softwares were used for meta-analysis. Results    The selected 15 cohort studies contained 45 770 patients, including 1 500 of BAV patients and 44 270 of TAV patients. The results showed that no statistical difference was found in postoperative in-hospital mortality [OR=1.29, 95%CI (0.91, 1.83), P=0.15], 30-day mortality [OR=1.23, 95%CI (0.86, 1.77), P=0.25], and 1-year mortality [OR=1.14, 95%CI (0.87, 1.50), P=0.33] between the two groups. The surgical success rate [OR=0.57, 95%CI (0.44, 0.74), P<0.01], postoperative bleeding events [OR=0.72, 95%CI (0.58, 0.91), P<0.01] and postoperative vascular injury [OR=0.68, 95%CI (0.47, 0.97), P=0.03] of patients in the BAV group were lower than those in the TAV group. The incidence of paravalvular leak in the BAV group was higher than that in the TAV group [OR=1.47, 95%CI (1.13, 1.90), P<0.01]. No significant difference was found between the two groups in terms of conversion to surgery, postoperative myocardial infarction, postoperative renal failure, postoperative neurologic events, postoperative valve gradient difference and pacemaker implantation. Conclusion    Compared with TAV, the application of TAVR in BAV patients is feasible and effective.

Effect of miR-137 on the proliferation and apoptosis of endothelial cells regulated by AKT2 gene / 中华医学遗传学杂志

OBJECTIVE@#To assess the effect of miR-137 on the proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) induced by high glucose and its mechanism.@*METHODS@#HUVECs cells were divided into low-glucose group (5.5 mmol/L glucose-treated cells), high-glucose group (33.36 mmol/L glucose-treated cells), anti-NC group (cells treated with 33.36 mmol/L glucose after anti-NC transfection) and anti-miR-137 group (cells treated with 33.36 mmol/L glucose after anti-miR-137 transfection). After 48 hours, qRT-PCR was used to determine the expression of miR-137. CCK-8 assay and flow cytometry were used to detect cell proliferation and apoptosis rate, respectively. The targeting relationship between miR-137 and AKT2 was validated by dual fluorescence reporter gene detection system and AKT2 protein expression after overexpression or inhibition of miR-137.@*RESULTS@#High glucose could significantly up-regulate the expression of miR-137 in HUVECs cells, and the expression of miR-137 in HUVECs cells transfected with miR-137 inhibitor was significantly decreased (P<0.05). High glucose can significantly inhibit HUVECs cell proliferation and induce apoptosis, while inhibition of miR-137 expression can weaken the effect of high glucose on HUVECs cell proliferation inhibition and apoptosis promotion (P<0.05). Inhibiting AKT2 expression could weaken the inhibitory effect of miR-137 inhibitor on HUVECs cell proliferation and apoptosis (P<0.05).@*CONCLUSION@#Inhibiting the expression of miR-137 gene can attenuate the proliferation inhibition and apoptosis promotion of HUVECs induced by high glucose, and the mechanism is related to activating the expression of AKT2.

Association of adolescent smoking history and onset age of diabetes with diabetic retinopathy / 中华内分泌代谢杂志

A total of 820 patients who visited Endocrinology department in our hospital were enrolled in the study from June 2016 to May 2018. These patients were divided into diabetic retinopathy ( DR ) and non-diabetic retinopathy ( NDR) groups according to the occurrence of DR. Factors such as gender, age, course of diabetes, smoking/drinking history, family history of diabetes, and onset age of diabetes were compared between the two groups, and logistic regression was used to analyze the risk factors of DR. The results showed that there were 387 smoker( 47. 2％) and 433 non-smoker ( 52. 8％) in 820 tyge 2 diabetic patients, and 339 ( 41. 3％) patients were diagnosed with DR. There were no statistical differences in gender, age, body mass index, family history of diabetes, drinking history, and HbA1C between the two groups. Logistic regression analysis showed that duration of diabetes (OR=2.653,P<0.001), hypertension(OR=1.371,P=0.041),onset age of diabetes<40years(OR=1.526,P=0.028) , and adolescent smoking history( OR=2.178,P<0.001) were independent risk factors for DR.

Diagnostic value of magnetic resonance imaging and hydrogen ion magnetic resonance spectroscopy for central neurocytoma / 中国基层医药

Objective@#To analyze the clinical value of magnetic resonance imaging (MRI) and hydrogen proton magnetic resonance spectroscopy (~1H-MRS) in the diagnosis of central neurocytoma (CNC).@*Methods@#From February 2010 to February 2018, the clinical data of 12 patients with CNC confirmed by surgery and pathology in Quzhou People's Hospital were retrospectively analyzed.All patients underwent MRI diagnosis before operation.Among them, 9 patients received ~1H-MRS check.@*Results@#In this group of 12 patients, 9 patients occurred in the 2/3 area of the lateral ventricle, 2 cases occurred in the posterior third of the lateral ventricle, 1 case occurred in the frontal lobe; 11 cases were solid tumors, and 1 case was cystic tumors.MRI showed plaque calcification in the tumor, distortion of vascular shadow, T1WI was equal low signal, T2WI was contoured mixed signal; 8 cases showed uneven light and moderate enhancement, 3 cases showed uneven enhancement, 1 case showed ring enhancement; 8 cases of ~1H-MRS showed a significant increase in choline peak (Cho), N-acetylaspartate (NAA) peak decreased, and Cho/NAA increased.Meanwhile, 1 case of glycine peak (Gly) increased.@*Conclusion@#CNC has specific MRI performance, and plays an important role in preoperative diagnosis and differential diagnosis.Combined with ~1H-MRS examination, it can grasp the tumor biochemical index and metabolism from the molecular level and improve the accuracy of preoperative diagnosis.

Clinical value of multi-slice spiral CT in the diagnosis of esophageal fistula after radiotherapy for esophageal cancer / 中国基层医药

Objective@#To investigate the application of multi-slice spiral CT in the diagnosis of esophageal fistula after esophageal cancer radiotherapy.@*Methods@#The subjects who were suspected to have esophageal fistula after radiotherapy for esophageal cancer admitted to the People's Hospital of Quzhou from January 2015 to February 2017 were randomly divided into A group and B group by means of lottery, with 15 cases in each group.The detection scheme of A group was multi-slice CT (MSCT), and the diagnosis of B group was performed by routine esophagography.The diagnostic accuracy of the two groups was observed, and the rate of missed diagnosis was compared.The amount of contrast agent such as gargle, mediastinal gas accumulation, and pneumothorax was observed.@*Results@#After the multi-slice spiral CT technique in A group, the missed diagnosis rate was 0%, which was significantly lower than that of B group (40%), the difference was statistically significant (χ2=8.097, P=0.016). In A group, the amount of contrast agent used in the diagnosis process were (32.4±4.5)mL, (25.1±3.2)mL, (20.5±2.4)mL, (19.5±12.3)mL in the diagnosis of effusion, pneumothorax, pneumonia and empyema, which were significantly better than those in B group (t=14.325, 15.652, 16.534, 15.973, P=0.025, 0.018, 0.013, 0.017).@*Conclusion@#Esophageal cancer complicated with esophageal fistula, especially small fistula is difficult to observe, resulting in missed diagnosis, the use of multi-slice spiral CT technology combined with appropriate post-treatment can greatly improve the accuracy of diagnosis, and thus timely treatment of patients, it is recommended for use.

Intermittent abdominal pain and abdominal distension with fatigue and massive ascites in a 13-year-old boy / 中国当代儿科杂志

A 13-year-old boy was admitted due to intermittent abdominal pain for one year with massive ascites. The purified protein derivative (PPD) test after admission yielded positive results (3+), and ascites examination revealed a yellow color. There were 634×10 nucleated cells/L in the ascites, among which 82.2% were mononuclear cells and 17.8% were multinuclear cells. The Rivalta test yielded a positive result and revealed that the ascites was exudate, suggesting the possibility of tuberculosis infection. The symptoms were not relieved after isoniazid-rifampicin anti-tuberculosis therapy and symptomatic/supportive treatment. Plain CT scan of the abdomen and contrast-enhanced CT showed that the lesion was located at the left wall of the transverse colon, with uneven thickening of the peritoneum and heterogeneous enhancement. Colonoscopic biopsy found signet ring cells in the mucosa and immunohistochemical examination revealed Syn (-), CgA (-), CD56 (-), CK(pan) (+), CDX-2 (+), CK20 (+), Muc-1 (+) and Ki-67 (+, about 80%). PET-CT scan showed an abnormal increase in fluorodeoxyglucose metabolism, which was shown as a mass near the splenic flexure of the transverse colon, with a maximum standard uptake value of 9.9, indicating a highly active lesion; this was consistent with the metabolic changes of malignant tumors. Surgical operation was performed and intraoperative exploration revealed massive ascites, a hard mass located at the hepatic flexure of the colon, involvement of the serous coat and surrounding tissues, stenosis of the bowel, lymph node enlargement around the superior mesenteric vessels and the gastrocolic ligament, and multiple metastatic nodules in the greater omentum, the abdominal wall and the pelvic cavity. The results of postoperative pathology were consistent with those of colonoscopic biopsy, i.e., poorly differentiated mucinous adenocarcinoma of the transverse colon and partly signet-ring cell carcinoma. Therefore, the boy was diagnosed with colon signet-ring cell carcinoma with peritoneal metastasis and tuberculosis infection. When a child is suffering from intractable abdominal pain, unexplained intestinal obstruction and massive intractable ascites, the possibility of malignancy should be considered. Abdominal plain CT scan as well as contrast-enhanced CT scan should be performed as early as possible, and enteroscopy should be performed when necessary.

Expression of circular RNA hsa_circ_0014130 in lung adenocarcinoma cell lines and its effect on proliferation and invasion of lung adenocarcinoma cell line / 中华病理学杂志

Objective@#To investigate the function and mechanism of hsa_circ_0014130 in lung adenocarcinoma cell line and to find potential molecular inhibitors.@*Methods@#The hsa_circ_0014130 expression level detection and overexpression and subtraction experiments were performed using common cell lines of lung cancer (PC9, H1299, A549, HCC827, and BEAS-2B). qPCR was used to verify the proliferation and invasion of lung cancer cells by MTS and invasion assay, and then the targeted microRNA was searched through the database. Western blot was used to detect the downstream signaling pathways, and finally the effect of small molecule inhibitors was investigated on proliferation and invasion of non-small cell lung cancer.@*Results@#The expression level of hsa_circ_0014130 was up-regulated in the three cell lines, and both the overexpression plasmid and the subtractive siRNA were effectively transfected into the cells. Overexpression of hsa_circ_0014130 was able to promote the proliferation and invasion of tumor cells, and knockdown of hsa_circ_0014130 inhibited the proliferation and invasion of tumor cells. hsa_circ_0014130 was capable to target hsa-miR-566 to reduce its expression level and to inhibit epithelial-to-mesenchymal transition. The use of the small molecule inhibitor SB-431542 and simultaneous reduction of hsa_circ_0014130 significantly inhibited the proliferation and invasion of tumor cells.@*Conclusions@#The hsa_circ_0014130 promotes the invasion and proliferation of lung cancer cells by targeting hsa-miR-566 to enhance the expression of TWIST1, and its expression level can be significantly inhibited by the small molecule inhibitor SB-431542, which significantly inhibits the proliferation and invasion of lung cancer cells. Therefore,hsa_circ_0014130 is a potential lung cancer treatment target.

Effect of miR-137 on the proliferation and apoptosis of endothelial cells regulated by AKT2 gene / 中华医学遗传学杂志

Objective@#To assess the effect of miR-137 on the proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) induced by high glucose and its mechanism.@*Methods@#HUVECs cells were divided into low-glucose group (5.5 mmol/L glucose-treated cells), high-glucose group (33.36 mmol/L glucose-treated cells), anti-NC group (cells treated with 33.36 mmol/L glucose after anti-NC transfection) and anti-miR-137 group (cells treated with 33.36 mmol/L glucose after anti-miR-137 transfection). After 48 hours, qRT-PCR was used to determine the expression of miR-137. CCK-8 assay and flow cytometry were used to detect cell proliferation and apoptosis rate, respectively. The targeting relationship between miR-137 and AKT2 was validated by dual fluorescence reporter gene detection system and AKT2 protein expression after overexpression or inhibition of miR-137.@*Results@#High glucose could significantly up-regulate the expression of miR-137 in HUVECs cells, and the expression of miR-137 in HUVECs cells transfected with miR-137 inhibitor was significantly decreased (P<0.05). High glucose can significantly inhibit HUVECs cell proliferation and induce apoptosis, while inhibition of miR-137 expression can weaken the effect of high glucose on HUVECs cell proliferation inhibition and apoptosis promotion (P<0.05). Inhibiting AKT2 expression could weaken the inhibitory effect of miR-137 inhibitor on HUVECs cell proliferation and apoptosis (P<0.05).@*Conclusion@#Inhibiting the expression of miR-137 gene can attenuate the proliferation inhibition and apoptosis promotion of HUVECs induced by high glucose, and the mechanism is related to activating the expression of AKT2.

Effect of Berberine on endoplasmic reticulum stress and insulin resistance in skeletal muscle of metabolic syndrome rats and its mechanism / 中华老年医学杂志

Objective To investigate the effect of Berberine on insulin resistance and its mechanism in Otsuka Long-Evans Tokushima Fatty(OLETF) rats with metabolic syndrome(MS).Methods LETO(Long-evans Tokushima Otsuka)rats(the control group receiving standard normal diet,n=10)and diabetic OLETF rats(the MS group receiving high-fat diet for 24 weeks,n=30).Rats in the MS group were randomly divided into 3 subgroups(n=10,each subgroup).Each subgroup was gavaged with normal saline,high-dose Berberine(100 mg · kg-1 · d-1)and low-dose Berberine (50 mg · kg-1 · d-1) respectively,and the high-fat diet remained unchanged.After 6 weeks of berberine treatment,body weight,blood glucose and lipid metabolism parameters were determined.The oral glucose tolerance test(OGTT) and insulin tolerance test(ITT) were used to detect insulin resistance.Expression levels of the protein and mRNA of 78 kDa glucose-regulated protein (GRP7 8),Caspase-12 and CCAAT/enhancer-binding protein(C/EBP) homologous protein(CHOP) in skeletal muscles were detected by Western blot and RT-PCR.Results After Berberine treatment,the body weight,fasting plasma glucose,fasting insulin[(28.9 ± 2.0) mU/L,(31.5± 2.4) mU/L vs.(36.9 ± 4.7) mU/L],total cholesterol,triglycerides,and low-density lipoprotein cholesterol were decreased,while the high-density lipoprotein cholesterol(HDL-C) levels were increased in MS rats with high-dose berberine and low-dose berberine as compared with the control group (P ＜ 0.05) respectively.Berberine treatment could reduce the protein and mRNA expression levels of GRP78,Capase-12 and CHOP in the skeletal muscle of MS rats(P＜0.05).Conclusions Berberine may alleviate insulin resistance in rats with metabolic syndrome by reducing endoplasmic reticulum stress in skeletal muscle.

Diagnostic value of magnetic resonance imaging and hydrogen ion magnetic resonance spectroscopy for cen-tral neurocytoma / 中国基层医药

Objective To analyze the clinical value of magnetic resonance imaging ( MRI) and hydrogen proton magnetic resonance spectroscopy (～1H-MRS) in the diagnosis of central neurocytoma (CNC).Methods From February 2010 to February 2018,the clinical data of 12 patients with CNC confirmed by surgery and pathology in Quzhou People＇s Hospital were retrospectively analyzed.All patients underwent MRI diagnosis before operation.Among them,9 patients received ～1H-MRS check.Results In this group of 12 patients,9 patients occurred in the 2/3 area of the lateral ventricle,2 cases occurred in the posterior third of the lateral ventricle,1 case occurred in the frontal lobe;11 cases were solid tumors,and 1 case was cystic tumors.MRI showed plaque calcification in the tumor, distortion of vascular shadow,T1WI was equal low signal,T2WI was contoured mixed signal;8 cases showed uneven light and moderate enhancement,3 cases showed uneven enhancement,1 case showed ring enhancement;8 cases of～1H-MRS showed a significant increase in choline peak (Cho),N-acetylaspartate (NAA) peak decreased,and Cho/NAA increased. Meanwhile, 1 case of glycine peak ( Gly) increased. Conclusion CNC has specific MRI performance,and plays an important role in preoperative diagnosis and differential diagnosis.Combined with ～1H-MRS examination,it can grasp the tumor biochemical index and metabolism from the molecular level and improve the accuracy of preoperative diagnosis.