One Novel Phantom-Less Quantitative Computed Tomography System for Auto-Diagnosis of Osteoporosis Utilizes Low-Dose Chest Computed Tomography Obtained for COVID-19 Screening.

Background: The diagnosis of osteoporosis is still one of the most critical topics for orthopedic surgeons worldwide. One research direction is to use existing clinical imaging data for accurate measurements of bone mineral density (BMD) without additional radiation. Methods: A novel phantom-less quantitative computed tomography (PL-QCT) system was developed to measure BMD and diagnose osteoporosis, as our previous study reported. Compared with traditional phantom-less QCT, this tool can conduct an automatic selection of body tissues and complete the BMD calibration with high efficacy and precision. The function has great advantages in big data screening and thus expands the scope of use of this novel PL-QCT. In this study, we utilized lung cancer or COVID-19 screening low-dose computed tomography (LDCT) of 649 patients for BMD calibration by the novel PL-QCT, and we made the BMD changes with age based on this PL-QCT. Results: The results show that the novel PL-QCT can predict osteoporosis with relatively high accuracy and precision using LDCT, and the AUC values range from 0.68 to 0.88 with DXA results as diagnosis reference. The relationship between PL-QCT BMD with age is close to the real trend population (from ∼160 mg/cc in less than 30 years old to ∼70 mg/cc in greater than 80 years old for both female and male groups). Additionally, the calculation results of Pearson's r-values for correlation between CT values with BMD in different CT devices were 0.85-0.99. Conclusion: To our knowledge, it is the first time for automatic PL-QCT to evaluate the performance against dual-energy X-ray absorptiometry (DXA) in LDCT images. The results indicate that it may be a promising tool for individuals screened for low-dose chest computed tomography.

Combined nucleic acid assays for diagnosis of A19 vaccine-caused human brucellosis.

Brucellosis is a common zoonotic disease caused by Brucella and is an epidemic worldwide. Currently, the most effective way to prevent and control the disease in animals is to use live, attenuated vaccines A19 strain. In China, the live attenuated Brucella abortus vaccine is widely used in animal immunization. To detect and confirm which vaccine strain caused the infection, we developed a new method to distinguish A19 strain from non-A19 strains. By comparing the genomic sequences of A19 and wild strain 2,308, we identified signature sequences that are unique to A19. A PCR assay for specific A19 identification was developed based on the genetic marker ABC transporter permease gene. Samples from the outbreak patients were then analysed using the universal quantitative PCR and A19-specific PCR assay, and the A19 strain was successfully identified in them, providing pathogenic evidence of the vaccine-derived infection outbreak. This combined A19-specific differential diagnosis method can provide a means to distinguish between animal vaccine immunization, natural infection and human infection by the vaccine strain. This strategy also has applications in diagnosis, epidemiology and surveillance of A19-related immunizations or infections.

Clinical Observation on Addition and Subtraction Therapy of Huaganjian Combined with Jinlingzisan in Patients with Bile Reflux Gastritis with Stagnancy Heat of Liver and Stomach Syndrome / 中国实验方剂学杂志

Objective:To evaluate the efficacy of addition and subtraction therapy of Huaganjian combined with Jinlingzisan for bile reflux gastritis （BRG） with stagnancy heat of liver and stomach syndrome， and to investigate its effect on inflammatory factors and gastrointestinal hormones. Method:One hundred and fifty patients were divided into control group and observation group evenly according to random number table. The 68 patients in control group finished the treatment （5 cases of dropout， loss of follow-up and 2 cases of withdrawal）， and 69 patients in observation group completed the treatment （3 cases of dropout， loss of follow-up and 3 cases of withdrawal）. Patients in control group got oral Dalitong granules before the meal， 1 bag/time， 3 times/day. Patients in observation group got addition and subtraction therapy of Huaganjian combined with Jinlingzisan， 1 dose/day. The treatment continued for 4 weeks in both groups. Before the treatment， gastroscope was used to evaluate the degree of bile reflux and the condition of mucosa under gastroscope. Before and after treatment， scores of stagnancy heat of liver and stomach syndrome， patient reported outcome （PRO） scale of chronic gastrointestinal diseases， self rating anxiety scale （SAS）， and self rating depression scale （SDS） were recorded. A follow-up of 6 months was conducted to record the clinical recurrence. Levels of gastrin （GAS）， motilin （MTL）， cholecystokinin （CCK）， prostaglandin E2 （PGE2）， tumor necrosis factor-α （TNF-α）， and interleukin-8 （IL-8） were detected both before and after treatment. In addition， the safety was discussed. Result:Scores of degree of bile reflux， mucosa under gastroscope and stagnancy heat of liver and stomach syndrome in the observation group were lower than those in control group （<italic>P</italic><0.01）. Scores of 6 dimensions in PRO scale （dyspepsia， reflux， defecation， social， psychological， and general state） and scores of SAS and SDS in the observation group were lower than those in control group （<italic>P</italic><0.01）. Levels of CCK， TNF-α and IL-8 in the observation group were all lower than those detected in control group （P<0.01）， while levels of GAS and MTL were higher than those in control group （<italic>P</italic><0.01）. Observation group was superior to the control group in terms of efficacy for traditional Chinese medicine（TCM） syndrome and efficacy under gastroscope （<italic>Z</italic>=2.083， <italic>P</italic><0.05； <italic>Z</italic>=2.104， <italic>P</italic><0.05）. Clinical recurrence rate in observation group was 20.37% （11/54）， lower than 40.82% （20/49） in control group （<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn mathvariant="normal">2</mml:mn></mml:mrow></mml:msup></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002c.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic></alternatives></inline-formula>=5.105， <italic>P</italic><0.05）. No adverse reaction was found after oral administrationh of TCM. Conclusion:Addition and subtraction therapy of Huaganjian combined with Jinlingzisan can ameliorate the clinical symptoms， relieve anxiety and depression， improve the quality of life in patients with BRG and stagnancy heat of liver and stomach syndrome， improve the degree of bile reflux， promote the healing of gastric mucosa， reduce inflammatory reaction and regulate gastrointestinal hormones. It has good efficacy for TCM syndrome and under gastroscopy in a short term， and can reduce the recurrence rate with high safety in a long term.

Recurrent laryngeal nerve inlet zone lymph node metastasis in papillary thyroid cancer / 中华普通外科杂志

Objective:To explore the clinical significance of recurrent laryngeal nerve inlet zone(RLNIZ) lymph node metastasis in papillary thyroid cancer(PTC).Methods:The clinical data of the clinicopathologic characteristics of 738 cases with papillary thyroid cancer at our centers from Jul 2017 to Jun 2018 was retrospectively reviewed. 108 cases with RLNIZ lymph node dissection for pathological examination were included. The relationship between metastasis of RLNIZ lymph node and clinicopathologic characteristics was analyzed.Results:RLNIZ lymph node was detected in 12.3%(91/738)cases, the mean lymph node number in RLNIZ was 1.5±0.7, and 30.8%(28/91) cases suffered RLNIZ lymph node metastasis. RLNIZ lymph node metastasis(LNM) is associated with tumor size( P=0.028), capsular invasion( P=0.019), No. of central compartment LNM( P<0.001) and lateral neck LNM( P<0.001). No. of central compartment LNM was found to be the independent risk factor of RLNIZ lymph node metastasis. The incidence of dysphagia and inferior parathyroid damage was 0.9%(1/108)respectively. Conclusions:RLNIZ lymph node metastasis is common among PTC patients , therefore, RLNIZ lymph node should be routinely removed especially in patients with tumor size over 1cm、suspected capsular invasion and lateral neck lymph node metastasis confirmed by preoperative imaging examination.

Construction and application value of prognosis associated miRNA prediction model based on bioinforma-tics analysis in pancreatic cancer patients / 中华消化外科杂志

Objective:To construct a prognosis associated micro RNA(miRNA) prediction model based on bioinformatics analysis and evaluate its application value in pancreatic cancer patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 171 pancreatic cancer patients from the Cancer Genome Atlas (TCGA) (https: //cancergenome.nih.gov/) between establishment of database and September 2017 were collected. There were 93 males and 78 females, aged from 35 to 88 years, with a median age of 65 years. Of the 171 patients, 64 had complete clinicopathological data. Patients were allocated into training dataset consisting of 123 patients and validation dataset consisting of 48 patients using the random sampling method, with a ratio of 7∶3. The training dataset was used to construct a prediction model, and the validation dataset was used to evaluate performance of the prediction model. Nine pairs of miRNA sequencing data (GSE41372) of pancreatic cancer and adjacent tissues were downloaded from Gene Expression Omnibus database. The candidate miRNAs were selected from differentially expressed miRNAs in pancreatic cancer and adjacent tissues for LASSO-COX regression analysis based on the patients of training dataset. A prognosis associated miRNA prediction model was constructed upon survival associated miRNAs which were selected from candidate differentially expressed miRNAs. The performance of prognosis associated miRNA prediction model was validated in training dataset and validation dataset, the accuracy of model was evaluated using the area under curve (AUC) of the receiver operating characteristic curves and the efficiency was evaluated using the consistency index (C-index). Observation indicarors: (1) survival of patients; (2) screening results of differentially expressed miRNAs; (3) construction of prognosis associated miRNA model; (4) validation of prognosis associated miRNA model; (5) comparison of clinicopathological factors in pancreatic cancer patients; (6) analysis of factors for prognosis of pancreatic cancer patients; (7) comparison of prediction performance between prognosis associated miRNA model and the eighth edition TNM staging. Measurement data with normal distribution were represented as Mean± SD, comparison between groups was analyzed by the student- t test, and comparison between multiple groups was analyzed by the AVONA. Measurement data with skewed data were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Ordinal data were analyzed using the rank sum test. Correlation analysis was conducted based on count data to mine the correlation between prognosis associated miRNA model and clinicopathological factors. COX univariate analysis and multivariate analysis were applied to evaluate correlation with the results described as hazard ratio ( HR) and 95% confidence interval ( CI). HR<1 indicated the factor as a protective factor, HR>1 indicated the factor as a risk factor, and HR equal to 1 indicated no influence on survival. The Kaplan-Meier method was used to draw survival curve and calculate survival rates, and the Log-rank test was used for survival analysis. Results:(1) Survival of patients: 123 patients in the training dataset were followed up for 31-2 141 days, with a median follow-up time of 449 days. The 3- and 5-year survival rates were 16.67% and 8.06%. Forty-eight patients in the validation dataset were followed up for 41-2 182 days, with a median follow-up time of 457 days. The 3- and 5-year survival rates were 15.63% and 9.68%. There was no significant difference in the 3- or 5-year survival rates between the two groups ( χ2=0.017, 0.068, P>0.05). (2) Screening results of differentially expressed miRNAs. Results of bioinformatics analysis showed that 102 candidate differentially expressed miRNAs were selected, of which 63 were up-regulated in tumor tissues while 39 were down-regulated. (3) Construction of prognosis associated miRNA model: of the 102 candidate differentially expressed miRNAs, 5 survival associated miRNAs were selected, including miR-21, miR-125a-5p, miR-744, miR-374b, miR-664. The differential expression patterns of pancreatic cancer to adjacent tissues were up-regulation, up-regulation, down-regulation, up-regulation, and down-regulation, respectively, with the fold change of 4.00, 3.43, 3.85, 2.62, and 2.35. A prognostic expression equation constructed based on 5 survival associated miRNAs = 0.454×miR-21 expression level-0.492×miR-125a-5p expression level-0.49×miR-744 expression level-0.419×miR-374b expression level-0.036×miR-664 expression level. (4) Validation of prognosis associated miRNA model: The C-index of prognosis associated miRNA model was 0.643 and 0.642 for the training dataset and validation dataset, respectively. (5) Comparison of clinicopathological factors in pancreatic cancer patients: results of COX analysis showed that the prognosis associated miRNA model was highly related with pathological T stage and location of pancreatic cancer ( Z=45.481, χ2=10.176, P<0.05). (6) Analysis of factors for prognosis of pancreatic cancer patients: results of univariate analysis showed that pathological N stage, radiotherapy, molecular targeted therapy, score of prognosis associated miRNA model were related factors for prognosis pf pancreatic cancer patients ( HR=2.471, 0.290, 0.172, 2.001, 95% CI: 1.012-6.032, 0.101-0.833, 0.082-0.364, 1.371-2.922, P<0.05). Results of multivariate analysis showed that molecular targeted therapy was an independent protective factor for prognosis of pancreatic cancer patients ( HR=0.261, 95% CI: 0.116-0.588, P<0.05) and score of prognosis associated miRNA model≥1.16 was an independent risk factor for prognosis of pancreatic cancer patients ( HR=1.608, 95% CI: 1.091-2.369, P<0.05). (7) Comparison of prediction performance between prognosis associated miRNA model and the eighth edition TNM staging: in the training dataset, there was a significant difference in the prediction probability for 3- and 5-year survival of pancreatic cancer patients between prognosis associated miRNA model and the eighth edition TNM staging ( Z=-1.671, -1.867, P<0.05). The AUC of the prognosis associated miRNA model and the eight edition TNM staging for 3- and 5-year survival prediction was 0.797, 0.935 and 0.737 , 0.703, with the 95% CI of 0.622-0.972, 0.828-1.042 and 0.571-0.904 , 0.456-0.951. The C-index was 0.643 and 0.534. In the validation dataset, there was a significant difference in the prediction probability for 3- and 5-year survival of pancreatic cancer patients between prognosis associated miRNA model and the eighth edition TNM staging ( Z=-1.729, -1.923, P<0.05). The AUC of the prognosis associated miRNA model and the eight edition TNM staging was 0.750, 0.873 and 0.721 , 0.703, with the 95% CI of 0.553-0.948, 0.720-1.025 and 0.553-0.889, 0.456-0.950, respectively. The C-index was 0.642 and 0.544. Conclusions:A prognosis associated miRNA prediction model can be constructed based on 5 survival associated miRNAs in pancreatic cancer patients, as a complementation to current TNM staging and other clinicopathological parameters, which provides individual and accurate prediction of survival for reference in the clinical treatment.

The expression and clinical significance of miR-143-3p in papillary thyroid cancer / 中华内分泌外科杂志

Objective:To explore the expression and clinical significance of miR-143 in papillary thyroid cancer (PTC) .Methods:Tumor samples and adjacent tissues from 52 patients with PTC were obtained from Jan. 1st, 2018 to Mar. 31st, 2018 in Thyroid Surgery Department of the Affiliated Yantai Yuhuangding Hospital of Qingdao University. Quantitative reverse-transcriptase PCR (RT-qPCR) was used to measure the expression of miR-143 in those subjects. In addition, the relationship between the expression levels of miR-143 and the clinicopathological characteristics was analyzed.Results:RT-qPCR indicated that the expression of miR-143 was down-regulated in PTC, which was significantly lower than that in adjacent tissues ( t=-21.39, 95% CI: 18.20-15.07, P<0.001) . Low expression of miR-143 was related to the number of lymph node metastasis ≥3 in central compartment ( t=10.13, P=0.012) and lateral neck lymph node metastasis ( t=-4.67, P<0.001) . Conclusion:Downregulation of miR-143 in PTC is linked to the metastasis of PTC and may be a potential target for therapeutic intervention.

Current advances for bone regeneration based on tissue engineering strategies / 医学前沿

Bone tissue engineering (BTE) is a rapidly developing strategy for repairing critical-sized bone defects to address the unmet need for bone augmentation and skeletal repair. Effective therapies for bone regeneration primarily require the coordinated combination of innovative scaffolds, seed cells, and biological factors. However, current techniques in bone tissue engineering have not yet reached valid translation into clinical applications because of several limitations, such as weaker osteogenic differentiation, inadequate vascularization of scaffolds, and inefficient growth factor delivery. Therefore, further standardized protocols and innovative measures are required to overcome these shortcomings and facilitate the clinical application of these techniques to enhance bone regeneration. Given the deficiency of comprehensive studies in the development in BTE, our review systematically introduces the new types of biomimetic and bifunctional scaffolds. We describe the cell sources, biology of seed cells, growth factors, vascular development, and the interactions of relevant molecules. Furthermore, we discuss the challenges and perspectives that may propel the direction of future clinical delivery in bone regeneration.

Progresses of mechanisms of brain injuries of end-stage renal disease based on MRI / 中国医学影像技术

End-stage renal disease (ESRD) can lead to various serious neurological complications, acute cerebrovascular disease and cognitive impairment are the most common ones. In recent years, a variety of new MRI techniques have been applied to elucidate the underlying neuropathological mechanisms of brain injuries in ESRD, and some progresses has been made, which is of great significance for early diagnosis and treatment of this disease. The progresses of mechanisms of brain injuries of ESRD based on MRI were reviewed in this article.

Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study / 中华胃肠外科杂志

OBJECTIVE@#To analyze the current status of diagnosis and management of acute appendicitis (AA) in China.@*METHODS@#Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary.@*RESULTS@#A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001).@*CONCLUSIONS@#The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.

Phenolic acid derivatives of Euphorbia ebracteolata / 中国中药杂志

A variety of chromatographic methods were applied to research the chemical composition of the roots of Euphorbia ebracteolata. Meanwhile, the structures of these compounds were identified by spectroscopic data, such as 1D, 2D NMR and HR-ESI-MS. In the present research, a new phenolic acid compound, 1,3,4,5-tetrahydroxy-2-O-β-D-[(6'-Gallic acyl)-glucopyranyl] isopentane(1), was isolated from the roots of E. ebracteolata, as well as three known compounds, isopropyl-2-O-β-D-(6'-gallic acyl)-glucopyranoside(2), ellagic acid(3) and 3,4'-di-O-methylellagic acid(4) respectively. Additionally, compounds 2 and 4 were isolated from the Euphorbia genus for the first time.

Analysis of risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy (PD).Methods The retrospective case-control study was adopted.The clinicopathological data of 196 patients with PD who were admitted to First Affiliated Hospital of Dalian Medical University from September 2014 to July 2016 were collected.All the patients underwent PD.Observation indicators:(1) intra-and postoperative situations;(2) follow-up;(3) analysis of risk factors of pancreatic fistula after PD.All patients were followed up by outpatient examination and telephone interview to detect pancreatic fistula and peritoneal fluid collection up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as median (range).Count data and univariate analysis were done using the chi-square test.Logistic regression model was used for multivariate analysis.Results (1) Intra-and post-operative situations:all the 196 patients underwent surgeries successfully.The operation time,volume of intraoperative blood loss,number of intraoperative blood transfusion and non intraoperative blood transfusion were (439± 136) minutes,(686±280) mL,45 and 151 cases,respectively.Time to initial anal exsufflation,time of initial defecation and time for first diet after operation were (4.1 ±2.1) days,(5.1± 2.9) days and (3.1 ± 2.0) days.Of 76 patients,the content of diastase in the i ntraperitoneal drainage was 614 U/L (31-30 215 U/L) at postoperative day 1 and level of serum procalciton in was (0.7±0.4) ng/mL at postoperative day 3.Time for drainage tube removal of 196 patients was (14.6±7.1)days.Fifty four of 196 patients with postoperative complications were improved by symptomatic treatment,including 15 with intestinal obstruction,12 with delayed gastric emptying,11 with abdominal infection,9 with incision infection,7 with bleeding.Duration of postoperative hospital stay was (17.1 ±4.2)days.Results of pathological diagnosis of 196 patients showed 121 cases of pancreatic cancer,50 of intraductal papillary mucinous tumors of the pancreas,7ampullary carcinoma,15 of carcinoma of the lower end of the bile duct,and 3 of duodenum cancer.Pancreatic findings:pancreatic texture:95 cases were with soft pancreas and 101 with hard pancreas.Diameter of main pancreatic duct duct:101 cases had diameter of pancreatic duct duct ≥3 mm and 95 cases ＜3 mm.(2)Followup:all the 196 patients were followed up for 4-30 months,with a median follow-up time of 18 months.During follow-up time,the grade B/or C pancreatic fistula occurred in 37 cases.Of 16 patients with pancreatic fistularalated ascites,10 had readmission and were improved by symptomatic treatment.(3) Analysis of risk factors of pancreatic fistula after PD:the results of univariate analysis showed that the content of diastase in the intraperitoneal drainage at postoperative day 1,level of serum procalcitonin at postoperative day 3 and pancreatic texture were related factors affecting the pancreatic fistula after PD (x2 =6.569,5.902,13.517,P＜0.05).The results of multivariate analysis showed that the content of diastase in the intraperitoneal drainage at postoperative day 1 ≥600 U/L was an independent risk factor affecting the pancreatic fistula after PD (OR =9.135,95％confidence interval:2.247-37.130,P＜0.05).Conclusion The content of diastase in the intraperitoneal drainage at postoperative day 1 ≥ 600 U/L is an independent risk factor affecting the pancreatic fistula after PD.

Clinical study of nutritional support in patients with acute peritonitis caused by colonic perforation / 肠外与肠内营养

Objective:To investigate the effect of different postoperative nutritional support on the gastrointestinal function and nutritional status in acute colon peforation patients.Methods:60 cases of acute emergency operation patients with perforation of the colon,according to the given nutritional support treatment of the different ways,were divided into enteral parenteral joint nutrition (EN + PN) group and total parenteral nutrition (TPN) group.Clinical therapeutic effects of two groups were compared.Results:The results of EN + PN group were significantly better than the those in TPN group (P ＜ 0.05).Conclusion:EN + PN model can improve the postoperative nutritional status and accelerate the recovery of patients with acute colonic perforation.

Analysis of risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the risk factors of postoperative pancreatic fistula after pancreaticoduodenectomy (PD).Methods The retrospective case-control study was adopted.The clinicopathological data of 196 patients with PD who were admitted to First Affiliated Hospital of Dalian Medical University from September 2014 to July 2016 were collected.All the patients underwent PD.Observation indicators:(1) intra-and postoperative situations;(2) follow-up;(3) analysis of risk factors of pancreatic fistula after PD.All patients were followed up by outpatient examination and telephone interview to detect pancreatic fistula and peritoneal fluid collection up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as median (range).Count data and univariate analysis were done using the chi-square test.Logistic regression model was used for multivariate analysis.Results (1) Intra-and post-operative situations:all the 196 patients underwent surgeries successfully.The operation time,volume of intraoperative blood loss,number of intraoperative blood transfusion and non intraoperative blood transfusion were (439± 136) minutes,(686±280) mL,45 and 151 cases,respectively.Time to initial anal exsufflation,time of initial defecation and time for first diet after operation were (4.1 ±2.1) days,(5.1± 2.9) days and (3.1 ± 2.0) days.Of 76 patients,the content of diastase in the i ntraperitoneal drainage was 614 U/L (31-30 215 U/L) at postoperative day 1 and level of serum procalciton in was (0.7±0.4) ng/mL at postoperative day 3.Time for drainage tube removal of 196 patients was (14.6±7.1)days.Fifty four of 196 patients with postoperative complications were improved by symptomatic treatment,including 15 with intestinal obstruction,12 with delayed gastric emptying,11 with abdominal infection,9 with incision infection,7 with bleeding.Duration of postoperative hospital stay was (17.1 ±4.2)days.Results of pathological diagnosis of 196 patients showed 121 cases of pancreatic cancer,50 of intraductal papillary mucinous tumors of the pancreas,7ampullary carcinoma,15 of carcinoma of the lower end of the bile duct,and 3 of duodenum cancer.Pancreatic findings:pancreatic texture:95 cases were with soft pancreas and 101 with hard pancreas.Diameter of main pancreatic duct duct:101 cases had diameter of pancreatic duct duct ≥3 mm and 95 cases ＜3 mm.(2)Followup:all the 196 patients were followed up for 4-30 months,with a median follow-up time of 18 months.During follow-up time,the grade B/or C pancreatic fistula occurred in 37 cases.Of 16 patients with pancreatic fistularalated ascites,10 had readmission and were improved by symptomatic treatment.(3) Analysis of risk factors of pancreatic fistula after PD:the results of univariate analysis showed that the content of diastase in the intraperitoneal drainage at postoperative day 1,level of serum procalcitonin at postoperative day 3 and pancreatic texture were related factors affecting the pancreatic fistula after PD (x2 =6.569,5.902,13.517,P＜0.05).The results of multivariate analysis showed that the content of diastase in the intraperitoneal drainage at postoperative day 1 ≥600 U/L was an independent risk factor affecting the pancreatic fistula after PD (OR =9.135,95％confidence interval:2.247-37.130,P＜0.05).Conclusion The content of diastase in the intraperitoneal drainage at postoperative day 1 ≥ 600 U/L is an independent risk factor affecting the pancreatic fistula after PD.

Progression on molecular pathology of pancreatic neuroendocrine tumors / 中华内分泌外科杂志

Pancreatic neuroendoerine tumors (PNET) is a complicated and heterogeneous group of neoplasia,and the incidence of PNET is growing rapidly recently.The current study on PNET lags behind what is known of other pancreatic tumors.Therefore,understanding of the molecular pathology is important for improving the early diagnosis,treatment and prognosis.With the development of molecular biology,there are already several potential targets proved to have application role in treatment of PNET.Here,the authors present the current knowledge about the molecular alterations of PNET.

High dietary diversity supports large group size in Indo-Chinese gray langurs in Wuliangshan, Yunnan, China.

Identifying ecological factors underlying primate group size has been a central theme in primate behavioral ecology. The ecological constraints model proposes that increased group size leads to enhanced within-group feeding competition, necessitating increased travel to encounter additional or more productive feeding sites. Over the course of three years, we studied the largest known group (>80 individuals) of Trachypithecus crepusculus (Indo-Chinese gray langur) for 1738 hours during 213 days (including 96 full day follows) in Wuliangshan, China. During this period, group size increased from 81 individuals to over 90 individuals. The group consumed plant parts from 27 ± 8 (range: 15-51) species per month, and a total 148 plant species during the study. Based on time spent feeding, the diet was similar (54.2% leaves and 32.1% fruit and seeds) to that reported for other colobines. Despite occupying a home range several times larger than other groups of Trachypithecus, we found no evidence of an increase in daily path length with increasing group size, and the group's time budget and daily path length remained relatively constant despite marked monthly changes in dietary pattern (e.g. time spent exploiting fruit and seeds vs. buds and young leaves, vs. mature leaves). These results are inconsistent with many of the predictions of the ecological constraints model. Rather, our data suggest that high dietary diversity and the ability to exploit difficult to digest foods enabled Indo-Chinese gray langurs to reduce opportunities for feeding competition associated with increased group size.

CXCL8 siRNA inhibits proliferation and invasion of human colon carcinoma cells through PI3K/Akt/NF-κB signaling pathway / 肿瘤

Objective: To investigate the effects of chemokine (C-X-C motif) ligand 8 (CXCL8) gene silencing on cell proliferation and invasion of human colon cancer cells, and to investigate its relationship with phosphatidylinositol 3-kinase/protein kinase B/nuclear factor-kappa B (PI3K/Akt/NF-κB) signaling pathway. Methods: The expression levels of CXCL8 mRNA and protein in four human colon cancer HT-29, WiDr, CaCo-2 and CoLo320 cells were detected by reverse transcription-PCR and Western blotting, respectively. The four colon cancer cells were transfected with the small interfering RNA targeting CXCL8 gene (CXCL8 siRNA) by LipofectAMINE 2000, then the expression of CXCL8 protein was detected by Western blotting. The proliferation and invasion abilities of colon cancer cells after CXCL8 gene silencing were detected by WST-1 method and Transwell invasion assay, respectively. The phosphorylation levels of PI3K, Akt and NF-κB proteins in HT-29 cells with CXCL8 gene silencing were detected by Western blotting. Results: CXCL8 mRNA and protein were highly expressed in four colon cancer cell lines. After CXCL8 siRNAs were transfected into the colon cancer cells, the expression of CXCL8 protein was significantly inhibited (all P < 0.01), while the proliferation and invasion abilities of colon cancer cells were significantly decreased (all P < 0.01). CXCL8 gene silencing resulted in blockage of PI3K, Akt and NF-κB protein phosphorylation induced by CXCL8 in colon cancer HT-29 cells (all P < 0.01). Conclusion: CXCL8 gene silencing significantly inhibits the proliferation and invasion of colon carcinoma cells. It may be related to down-regulation of protein activity in PI3K/Akt/NF-κB signaling pathway.

Distribution and conservation status of Rhinopithecus strykeri in China.

This paper summarizes the results of 358 interviews we conducted on Rhinopithecus strykeri in the Gaoligong Mountains, northwest Yunnan, China, between April 2011 and December 2012. Based on our interview records and selective field surveys (47 days of field survey for seven possible distribution areas), we suggest that there may be up to 10 groups of R. strykeri occurring in China between the Salween River and the border with Myanmar, and that the total population of R. strykeri in China should be between 490 and 620 animals. According to interviewees, Rhinopithecus strykeri tends to use conifer and mixed conifer-broad-leaved forest, predominantly between 2,600 and 3,100 m above sea level. To better protect this globally threatened species, classified as critically endangered by the International Union for Conservation of Nature (IUCN), we suggest extensions to current nature reserve boundaries to better include the home ranges of China's remaining population.

Clinical research on the correlations between type 2 diabetes mellitus and renal clear cell carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between renal clear cell carcinoma and type 2 diabetes mellitus (DM).</p><p><b>METHODS</b>Two hundreds and sixty-four patients with renal clear cell carcinoma and four hundred controls who suffered from non-urinary system, non-neoplastic or non-hormone-related disorders, were enrolled from January 2008 to December 2012. The incidence of diabetes between the 2 groups and the relationship between renal clear cell carcinoma and duration of diabetes were compared, moreover, renal clear cell carcinoma patients with DM were compared with patients without DM for their clinical features, laboratory examinations and histological characteristics.</p><p><b>RESULTS</b>The comparison of renal clear cell carcinoma group and control group: the incidence of DM in the two groups were 19.7% and 12.8% respectively, and the difference was significant (χ(2) = 5.86, P < 0.05, OR = 1.68). In the renal clear cell carcinoma group, the proportion of patients with DM diagnosed within 2-4 years was 4.92%, which were significant higher than those in the control group 1.70% (χ(2) = 5.49, P < 0.05, OR = 2.91). And men with diabetes had high occurrence risk 86% of renal clear cell carcinoma (OR = 1.86, 95%CI: 1.09-3.15). The comparison of diabetes patients subgroup and non-diabetic patients subgroup in renal clear cell carcinoma group: in respect of clinical features, greatest tumor diameter in the two subgroups were (4.9 ± 2.3) cm and (4.2 ± 2.1) cm respectively, and the difference was significant (t = 1.96, P < 0.05). However, there was no significant difference in terms of age, gender and cancer location between the two subgroups (P > 0.05). In respect of laboratory examinations, serum creatinine in the two subgroups were (72 ± 20) µmol/L and (65 ± 17) µmol/L, and the difference was significant (t = 2.34, P < 0.05); serum urea nitrogen in the 2 subgroups were (7.1 ± 2.1) mmol/L and (6.0 ± 1.5) mmol/L respectively, and the difference was significant too (t = 1.47, P < 0.05). In respect of histological characteristics, the proportion of well differentiated clear cell carcinoma were 80.8% and 81.1% respectively, and the difference was significant (χ(2) = 4.23, P < 0.05). The proportion of stage II were 25.0% and 27.8% respectively and the difference was significant (χ(2) = 4.08, P < 0.05).</p><p><b>CONCLUSIONS</b>DM is closely related with renal clear cell carcinoma and DM may be a possible risk factor for the tumor. And for elderly patients with diabetes who appear waist discomfort or hematuria, a careful examination of kidney is important to make early diagnosis, give timely treatment and improve survival prognosis.</p>

Effect of surface pretreatment with chemical etchants on bond strength between a silicone-based resilient liner and denture base resin / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of denture base resin surface pretreatment with chemical etchants on microleakage and bond strength between silicone-based resilient liner and denture base resin. The initial bending strength of denture base resin after surface pretreatment was also examined.</p><p><b>METHODS</b>Thirty-six polymethyl methacrylate (PMMA) denture base resin blocks (30 mm × 30 mm × 2 mm) were prepared and divided into three groups: group acetone, group methyl methy acrylate (MMA) and group control. Subsequently, a 2 mm silicone-based resilient liner was applied between every two blocks. After 5000 cycles in the thermal cycler (5 and 55°C), they were immersed in the (131) I solution for 24 hours and γ-ray counts were measured. Another 36 PMMA resin blocks (30 mm × 10 mm × 7.5 mm) were prepared. The blocks were divided into three groups and treated as mentioned above. A 3 mm silicone-based resilient liner was applied between every two blocks. After 5000 thermal cycles, tensile bond strength of the sample was measured in a universal testing machine. Another 18 PMMA resin blocks (65 mm × 10 mm × 3.3 mm) were prepared. They were divided into 3 groups and treated in the same way. After an adhesive was applied, the bending strength was measured with three-piont bending test.</p><p><b>RESULTS</b>Two experimental groups showed lower microleakage (520.0 ± 562.2 and 493.5 ± 447.9) and higher tensile bond strength [(1.5 ± 0.4) and (1.4 ± 0.5) MPa] than the group control [microleakage: (1369.5 ± 590.2); tensile bond strength: (0.9 ± 0.2) MPa, P < 0.05]. There was no statistically significant difference between group acetone and MMA in microleakage and tensile bond strength (P > 0.05). There was no statistically significant difference in bending strength among the three groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Treating the denture base resin surface with acetone and MMA decreased the microleakage, increased the tensile bond strength between the two materials and did not make the initial bending strength of denture base resin decline.</p>

Expression of soluble H1N1 haemegglutinin in two distinct insect baculovirus expression systems / 中华微生物学和免疫学杂志

Objective To express functional haemegglutinin(HA)protein in two different bacularvirus expression systems.Methods The whole open reading frame of A/Sichuan/1/2009(H1N1)HA was obtained by synthesis,and the HA protein were expressed in insect cells by two different bacularvius expression systems:BaculoGold system and Bac-to-Bac system. Soluble HA protein was identified by Western blot and haemegglutination test. Results The correct full length of HA gene was obtained and cloned into pAcGP67B and pFAST Bacl vectors,respectively.After 3 rounds of virus amplifyjng by re-infection of Sf9 cells,the HA protein was detected in supematant of BaculoGold system and in intracellular of Bac-to-Bac system which is much better than the former.Purified HA protein was positive not only identified by Western blot,but also detected by haemegglutinin test. Conclusion Functional HA protein was successfully expressed in two distinct bacularvirus expression systems,of which the Bac-to-Bac bacularvirus expression system is more suitable for expression of A/Sichuan/1/2009(H1N1)HA protein.