Correlation between bilateral GFR in patients with localized renal cancer after partial nephrectomy.

OBJECTIVE: To explore the relationship between the residual glomerular filtration rate (GFR) on the operated side and the GFR on the contralateral side following partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC). MATERIALS AND METHODS: Following institutional review board approval, we conducted a retrospective analysis of clinical records from May 2018 to July 2023, involving 118 patients who underwent partial nephrectomy for unilateral localized kidney tumors (T1-T2). Glomerular filtration rate data were assessed using single photon emission computed tomography (SPECT)/computed tomography imaging [using 9mTc-DTPA (diethylenetriaminepentaacetic acid) renal dynamic imaging]. The independent determinants of postoperative renal function or renal function change were determined using linear regression analysis. In addition, the patient's demographic, clinical, and nephrometry characteristics were collected. RESULTS: A total of 58 patients were finally enrolled. The preoperative and postoperative GFR of bilateral kidneys showed a significant positive correlation. Postoperative GFR of the operated kidney was the independent predictor of GFR of contralateral kidney (p = 0.001). Tumor diameter (p = 0.036), age (p = 0.005), and postoperative GFR of the contralateral kidney (p = 0.001) were all independent predictors of postoperative GFR of the operated kidney. ΔGFR1 was the independent predictor of ΔGFR2. Results showed that a more pronounced postoperative decline in GFR on the operated side corresponded to a weaker compensatory capacity of the contralateral-side kidney. CONCLUSIONS: During the course of the surgical procedure, the active endeavor to safeguard the renal function of the operated kidney side holds paramount importance, which yields positive outcomes for postoperative kidney function on the contralateral side, consequently contributing to the overall preservation of renal function.

Hedgehog pathway orchestrates the interplay of histone modifications and tailors combination epigenetic therapies in breast cancer

Epigenetic therapies that cause genome-wide epigenetic alterations, could trigger local interplay between different histone marks, leading to a switch of transcriptional outcome and therapeutic responses of epigenetic treatment. However, in human cancers with diverse oncogenic activation, how oncogenic pathways cooperate with epigenetic modifiers to regulate the histone mark interplay is poorly understood. We herein discover that the hedgehog (Hh) pathway reprograms the histone methylation landscape in breast cancer, especially in triple-negative breast cancer (TNBC). This facilitates the histone acetylation caused by histone deacetylase (HDAC) inhibitors and gives rise to new therapeutic vulnerability of combination therapies. Specifically, overexpression of zinc finger protein of the cerebellum 1 (ZIC1) in breast cancer promotes Hh activation, facilitating the switch of H3K27 methylation (H3K27me) to acetylation (H3K27ac). The mutually exclusive relationship of H3K27me and H3K27ac allows their functional interplay at oncogenic gene locus and switches therapeutic outcomes. Using multiple in vivo breast cancer models including patient-derived TNBC xenograft, we show that Hh signaling-orchestrated H3K27me and H3K27ac interplay tailors combination epigenetic drugs in treating breast cancer. Together, this study reveals the new role of Hh signaling-regulated histone modifications interplay in responding to HDAC inhibitors and suggests new epigenetically-targeted therapeutic solutions for treating TNBC.

Effects of colpotomic approaches on prognosis and recurrence sites of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy / 中华妇产科杂志

Objective:To investigate the factors affecting the prognosis of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy (LRH), and to compare the prognosis and recurrence sites of patients with different colpotomy paths.Methods:The clinical data of 965 patients with stage Ⅰa2-Ⅱa2 cervical cancer who underwent LRH in the First Affiliated Hospital of Army Medical University from January 2015 to December 2018 were collected. The median age was 47.0 years of all patients with a median follow-up of 62 months (48-74 months). Cox regression was used to perform the univariate and multivariate analysis of the clinicopathological factors associated with the prognosis that included disease-free survival (DFS) and overall survival (OS). Patients were categorized into LRH through vaginal colpotomy (VC group, n=475) and LRH through intracorporeal colpotomy (IC group, n=490) according to the colpotomic approaches. The prognosis and recurrence sites of patients in each group were compared. Results:(1) During the follow-up period, 137 cases recurred (14.2%, 137/965) and 98 cases died (10.2%, 98/965). The 5-year DFS and OS were 85.8% and 89.9%, respectively. In univariate analysis, positive vaginal margin (PVM) was significantly affected the 5-year OS of patients with cervical cancer ( P=0.023), while clinical stage, maximum diameter of tumor, degree of pathological differentiation, lymph node metastasis (LNM), depth of cervical stromal invasion, parametrium involvement, and uterine corpus invasion (UCI) were significantly associated with 5-year DFS and OS in patients with cervical cancer (all P<0.05). In multivariate analysis, clinical stage ( HR=1.882, 95% CI: 1.305-2.716), LNM ( HR=2.178, 95% CI: 1.483-3.200) and UCI ( HR=3.650, 95% CI: 1.906-6.988) were independent risk factors of 5-year DFS (all P<0.001). Clinical stage ( HR=2.500, 95% CI: 1.580-3.956), LNM ( HR=2.053, 95% CI: 1.309-3.218), UCI ( HR=3.984, 95%C I: 1.917-8.280), PVM ( HR=3.235, 95% CI: 1.021-10.244) were independent risk factors of 5-year OS (all P<0.05). (2) Different colpotomy paths did not significantly affect the 5-year DFS and OS of patients with stage Ⅰa2-Ⅱa2 cervical cancer. The 5-year DFS in VC group and IC group were 85.9% and 85.6% ( P=0.794), and the 5-year OS were 90.8% and 89.3% ( P=0.966), respectively. Recurrence patterns consisted of intraperitoneal recurrence, pelvic recurrence, vaginal stump recurrence, and lymph node and distant metastasis. The intraperitoneal recurrence rate of VC group was significantly lower than that of IC group [0.6%(3/468) vs 2.3% (11/485), P=0.037], while the rates of pelvic recurrence, vaginal stump recurrence, lymph node and distant metastasis and overall recurrence were not significantly different between two groups (all P>0.05). Subgroup analysis of patients with different clinical stages, LNM and UCI showed that statistical differences of the intraperitoneal recurrence rates between two groups were only in patients without LNM (0.5% vs 2.3%, P=0.030) or without UCI (0.7% vs 2.3%, P=0.037). Conclusions:Clinical stage, LNM, PVM and UCI are independent risk factors for the prognosis of patients with stage Ⅰa2-Ⅱa2 cervical cancer. For patients without LNM or UCI, LRH through VC could reduce the intraperitoneal recurrence rate, while it is not enough to improve 5-year DFS and OS of patients. Low proportion of intraperitoneal recurrence, intra-operative tumor cells spillage to vagina stump and pelvic cavity might be the explanation.

Research Progress of Mesenchymal Stem Cells and Their Exosomes on Tumors / 中国肺癌杂志

In China, malignant tumor is the main cause of death in both urban and rural areas. Mesenchymal stem cells (MSCs) have multidirectional differentiation potential, self-renewal ability and good immunomodulatory properties. Exosomes, as important paracrine substances of MSCs, mediate information exchange and transmission between cells in tumor microenvironment and influence the occurrence and development of tumors. Recently, conflicting findings have been reported on the effects of MSCs and their exosomes on tumors. On the one hand, MSCs and their exosomes are tumorigenic and can target specific sites to inhibit tumor growth; On the other hand, there is also evidence that MSCs could affect tumor growth and migration as part of the tumor microenvironment. In this paper, we will review the relationship between MSCs and exosomes and tumorgenesis and development, as well as how MSCs and exosomes play different roles in tumorgenesis and development, in order to provide beneficial help for tumor diagnosis, prognosis and precise treatment.
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A prospective multicenter cohort study comparing vNOTES and laparoscopic sentinel lymph node mapping for endometrial cancer / 부인종양

Objective@#To determine the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in hysterectomy and sentinel lymph node (SLN) mapping for endometrial cancer by comparing its SLN detection rate and perioperative outcomes with those of laparoscopic staging. @*Methods@#In this multicenter prospective cohort study, 68 patients with early endometrial cancer between 2020 and 2021 in 2 tertiary referral centers in China were grouped to vNOTES (n=33) or laparoscopy (n=35). All the patients underwent hysterectomy with SLN mapping. @*Results@#The total successful SLN detection was 97.0% in the vNOTES group and 91.4% in the laparoscopy group (p=0.32), whereas the bilateral success rates were 81.8% and 80.0%, respectively (p=0.84). There was no difference in SLN detection observed between the 2 groups regarding the side-specific mapping efficacy quotient (89.4% vs 85.7%; p=0.05). The number of harvested SLNs, the location of SLNs, operative time, estimated blood loss, intraoperative and postoperative complications and hospital cost in the 2 groups were similar (p>0.05), but there were differences in the 2 groups; the one was postoperative exhaust time that was 18 vs. 21 hours (p=0.01), the other was median postoperative hospital stay which was 4 vs. 5 days (p=0.05). @*Conclusion@#This study suggests that lymph node mapping can be completed through the vNOTES procedure. It can ensure effective surgical staging and show the advantages of a fast recovery and good cosmetic effect.

Research progress on the interactions between gut bacterial β-glucuronidases and Chinese herbal medicines / 药学学报

In traditional oral practice, the presystemic interactions with gut microbiota is an important mechanism underlying the holistic health benefits of Chinese herbal medicines (CHMs), making the study of CHMs distinct from the research of Western medicines of which the systemic exposure (level in blood) is the starting point and the core. Gut microbial metabolism complements host metabolism in maintaining metabolic homeostasis of many biologically important endogenous molecules and the disposition of numerous exogenous compounds. Among them, the widely distributed gut bacterial β-glucuronidases (BGUSs) coordinate with host UDP-glucuronosyltransferases (UGTs) to play a role in the occurrence and intervention of diseases by affecting the glucuronidation homeostasis and altering the intestinal local and/or systemic exposure of endogenous compounds and xenobiotics. On one hand, many ingredients of CHMs undergo enterohepatic circulation; On the other hand, CHMs can act on BGUSs directly or indirectly change the distribution and function of BGUSs through reprogramming gut microbiome. The multiple interactions between BGUSs and CHMs may play an important role in the overall therapeutic benefits of CHMs. This work firstly summarizes the latest research progress on BGUSs; then the physiological, pathological and pharmacological significance of BGUSs are exemplified with representative endogenous and exogenous compounds from the aspects of nutrient utilization, metabolic homeostasis, and therapeutic response based on the varied substrate spectra of BGUSs; finally, the scattered data in literature were integrated to summarize the multiple interactions between BGUSs and CHMs, highlighting the important role of BGUSs in the holistic actions of CHMs.

Influencing factors of the effect of anti-retroviral therapy in female commercial sex workers with human immunodeficiency virus positive in Guangxi Zhuang Autonomous Region / 中华传染病杂志

Objective:To investigate the effect and influencing factors of anti-retroviral therapy (ART) in human immunodeficiency virus (HIV)-positive female commercial sex workers (CSW) in Guangxi Zhuang Autonomous Region.Methods:A retrospective cohort study was used in this study. A total of 661 HIV-positive CSW receiving ART from the Guangxi Zhuang Autonomous Region′s municipal and county-level Centers for Disease Control and Prevention (CDC) reported to Guangxi Zhuang Autonomous Region CDC from January 1, 2009 to December 31, 2018 were included.The demographic information of the patients, marital status, past medical history, acquired immunodeficiency syndrome (AIDS)-related diseases after six to 12 months of ART, medications, CD4 + T lymphocytes, virological and immunological effects after receiving ART for six to 12 months were collected. Logistic regression model was used to analyze the influencing factors of virological failure and immunological failure of HIV-positive CSW after six to 12 months of ART. Results:Among 661 HIV-positive CSW, 50(7.6%) cases experienced virological failure, 80(12.1%) cases experienced immunological failure, and 13(2.0%) had both virological failure and immunological failure.There were 85 cases (12.9%) who had a history of sexually transmitted diseases. Multivariate logistic regression analysis showed that unmarried (adjusted odds ratio (a OR)=3.298, 95% confidence interval ( CI) 1.285 to 8.461), AIDS-related diseases after six to 12 months of ART (a OR=4.391, 95% CI 1.555 to 12.402) and missed medications in the last seven days (a OR=3.731, 95% CI 1.942 to 7.166) were risk factors for virological failure. Compared with CD4 + T lymphocytes<200.00/μL at baseline, 350.00≤CD4 + T lymphocytes <500.00/μL (a OR=3.543, 95% CI 1.631 to 7.701) and CD4 + T lymphocytes≥500.00/μL (a OR=2.358, 95% CI 1.002 to 5.547) were risk factors for immunological failure. Conclusions:HIV-positive CSW in Guangxi Zhuang Autonomous Region have a better treatment effect, with low rates of virological failure and immunological failure. Marital status, baseline CD4 + T lymphocyte counts, AIDS-related diseases after six to 12 months of ART, and missed medication in the last seven days are factors influencing the effect of six to 12 months of ART.

The effects of continuous proton pump inhibitor therapy on small intestinal bacterial overgrowth in elderly / 中华内科杂志

Objective:Long-term proton pump inhibitor(PPI) therapy may increase the risk of small intestinal bacterial overgrowth(SIBO). Few studies on the effect of on-demand and continuous PPI therapy are available in elderly. To investigate the prevalence of SIBO and the effect of on-demand and continuous PPI therapy on SIBO in elderly.Methods:A total of 200 elderly outpatients admitted to Department of Gastroenterology at the Second Medical Center of PLA General Hospital were enrolled and divided into 3 groups: continuous PPI group, on-demand PPI group and control group. SIBO was diagnosed according to methane and hydrogen lactulose breath test (LBT).The prevalence of SIBO in the 3 groups was analyzed.Results:The prevalence of SIBO was 71.5% in 200 elderly. PPI therapy and diabetes mellitus (DM) were independent risk factors for SIBO. The prevalence of SIBO was 77.1% (108/140) in elderly who underwent long-term PPI therapy and 58.3% (35/60) in those without PPI therapy ( P<0.01).The prevalence of SIBO was significantly higher in continuous PPI therapy group than that in on-demand PPI group and control group(88.6% vs. 65.7% and 58.3%, all P<0.01).However, no significant difference was found in the prevalence of SIBO between on-demand PPI group and control group ( P>0.05). In elderly who underwent long-term PPI therapy, the prevalence of SIBO increased significantly if administration time was longer than 61 months. Conclusions:SIBO usually occurs in elderly patients who receive continuous PPI rather than on-demand use. If elderly require long-term PPI therapy, on demand administration is suggested as long as primary diseases are properly treated.

Epidemiological characteristics of HIV/AIDS in Guangxi Zhuang Autonomous Region, 2010-2017 / 中华流行病学杂志

Objective@#To understand the characteristics of HIV/AIDS epidemic in Guangxi Zhuang Autonomous Region (Guangxi) with a purpose to accurately provide scientific basis for prevention and control measures, 2010-2017.@*Methods@#Data were retrieved from case reporting cards of Guangxi during 2010 to 2017 through National HIV/AIDS Comprehensive Response Information Management System. Data was analyzed using epidemiological methods such number of cases, proportion and rate. χ2 test was used for statistical analysis.@*Results@#The HIV positive rate was 12.53 per ten thousand (85 182/67 959 000) in Guangxi during 2010 to 2017. The number of newly diagnosed HIV/AIDS cases and the number of death yearly respectively increased by 22.34%(2 602/11 648) and 32.83% (952/2 900) in 2011 compared with 2010, and both showed a six-year continuous downward trend (the number of newly diagnosed cases respectively 12 229 cases, 10 877 cases, 9 460 cases, 9 190 cases, 8 848 cases, 8 680 cases, and the number of death respectively 3 888 cases, 3 316 cases, 2 914 cases, 2 717 cases, 2 595 cases, 2 600 cases) from 2012 to 2017. But proportion of late discovery remained above 50.00% (50.53%-57.06%) for eight-years continuously. The ratio of male and female was 2.47 ∶ 1 (60 639/24 543). The ratio of males and females aged 50 and over was 2.71∶1 (28 654/10 557). Proportion of the cases in 25-49 years old group and 50 years old group accounting for 47.40%(40 377/85 182) and 46.03% (39 211/85 182) respectively. The occupation was farmers accounting for 68.40% (58 262/85 182), housekeeping, housework and unemployment accounting for 11.21% (9 546/85 182), student accounting for 0.86% (729/85 182). Heterosexual transmission accounted for 90.60% (77 171/85 182, homosexual transmission accounted for 3.13% (2 669/85 182), injection drug use transmission accounted for 4.60%(3 924/85 182) and mother-to-child transmission accounted for 0.73% (619/85 182).@*Conclusions@#The number of newly diagnosed cases and the number of death yearly showed a continuous downtrend for six-years from 2012 to 2017. However, proportion of late discovery remained above 50.00% for eight-years. The major route of infection was heterosexual transmission. With the change of HIV/AIDS newly epidemic mode in Guangxi, there are many new challenges for HIV/AIDS prevention and control work. Strategy of targeted intervention modes should be innovated for a new breakthrough.

HIV, syphilis and behavioral risk factors among men who have sex with men in a drug-using area of southwestern China: Results of 3 cross-sectional surveys from 2013 to 2015.

To assess human immunodeficiency virus (HIV), syphilis, and behavioral risk factors among men who have sex with men (MSM) in southwestern China, where HIV started as a drug-driven epidemic, and shifted to mainly heterosexual transmission.These cross-sectional studies were conducted yearly in 2013, 2014, and 2015 in Guangxi, China. A total of 1,996, 1,965, and 1,697 participants were recruited in 2013, 2014, and 2015, respectively. The data included demographic and sexual behavioral variables. Other variables included individuals who used illegal drugs, and who received HIV counseling, testing, and free condoms, and peer education. Participants were tested for HIV, syphilis, and hepatitis C virus (HCV) with whole blood specimens. Questionnaires and laboratory testing data were double entered, and validated with EpiData software. The data were then transferred into SPSS software (SPSS Inc, Chicago, IL) and Chi-square test performed.The prevalence of HIV was 6.6% in 2013, 8.4% in 2014, and 11.2% in 2015. The prevalence of syphilis was 9.3% in 2013, 9.8% in 2014, and 6.1% in 2015. And HCV prevalence was 0.5% in 2013 and remained stable at 0.4% in 2014, and 2015. HIV infection, and associated factors among MSM in these 3 annual cross-sectional survey showed that HIV-infected MSM were significantly, more likely, to perform unprotected anal intercourse with any commercial male partners in the past 6 months (adjusted odds ratio [AOR] = 1.81, 95% CI: 1.50-2.20), had sex with any female partners in the past 6 months (AOR = 1.31, 95% CI: 1.01-1.71), used drugs in the past (AOR = 2.73, 95% CI: 1.30-5.71), and are syphilis infected (AOR = 3.53, 95% CI: 2.77-4.49).There is an urgent need for intervention strategies like condom distribution, HIV counseling, free testing, and education regarding safe sex, HIV, and other sex-related diseases in Guangxi to curb, and prevent HIV among MSM.

Bedside ultrasound measurement of gastric content and volume / 基础医学与临床

Perioperative pulmonary aspiration is a serious complication during general anesthesia .For patients with un-known gastric condition , there is no effective method for the noninvasive evaluation of gastric content and volume preop-eratively.Because of the portable and real-time detection, bedside ultrasound can significantly reduce the risk of periop-erative reflux and pulmonary aspiration , which makes preoperative gastric contents visualized and accurate .

Analysis of influencing factors of affected renal function after laparoscopic nephron-sparing nephrectomy with segmental renal artery blocking for small renal tumor / 中华泌尿外科杂志

Objective To analyze the influencing factors of affected renal function after laparoscopic nephron-sparing nephrectomy with segmental renal artery blocking (SRPN) for low R.E.N.A.L.score small localized renal tumor with follow-up data.Methods The data of 33 patients was collected,who underwent SRPN for small renal tumor from January 2010 to April 2012,and were followed-up for 5 years successfully.In 33 integrated data of 5-year follow-up,there were 14 males and 19 females,aged(56.5 ± 11.8)years.The preoperative affected renal glomerular filtration rate (aGFRpre),postoperative affected renal glomerular filtration rate (aGFRpost),the residual ratio of aGFR (aGFRpost/aGFRpre),preoperative affected renal volume (aVolpre),postoperative affected renal volume (aVolpost) and the residual ratio of aVol (aVolpost/aVolpre) were collected at the postoperative 3rd,6th,12th,24th and 60th month in follow-up period.Preoperative and postoperative data were analyzed by paired-sample T test.Multivariate linear regression analysis determined the influence of body mass index,operation time,localized warm ischemia time and distance from tumor to renal collecting system.Compare the correlation between aGFRpost/aGFRpre and aVolpost/aVolpre.Results All 33 cases were performed successfully.The mean operation time was (108.4 ± 9.1) min,and the mean time of segmental renal artery blocking was (23.3 ± 3.0) min.Postoperative pathologic 17 (51.5％) of clear cell carcinoma,5 (15.2％) of papillary carcinoma,3 (9.1％) of chromophobe cell carcinoma.All of above margins were negative.8 (24.2％) of angiomyolipoma (9.1％).All 33 cases were followed up for more than 5 years.The 5-year overoll survival (OS) and cancer specific survival (CSS) were 100％.In the 3rd,6th,12th,24th and 60th month,aGFRpost were (34.6 ± 4.6) ml/min,(34.7 ± 4.8) ml/min,(34.9 ± 4.4) ml/min,(35.1 ± 4.4) ml/min,(35.2 ± 4.2) ml/min,decreased of (10.4 ± 2.4) ml/min,(10.4 ± 2.6) ml/min,(10.1 ± 2.4) ml/min,(9.9 ± 2.4) ml/min,(9.8 ± 2.5) ml/min compared with aGFRpre (P ＜ 0.05).Multivariate linear regression analysis showed that body mass index,operation time,localized warm ischemia time in SRPN and distance from tumor to renal collecting system were unable to influence aGFRpost (P ＞ 0.05).The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659,0.667,0.663,0.629,0.604 respectively,and the difference was statistically significant (P ＜ 0.05).Conclusions For low R.E.N.A.L.score small localized renal tumor with SRPN,the decrease of postoperative affected renal function is relevant to postoperative affected renal volume,not as to operation time,localized warm ischemia time in SRPN and distance from tumor to renal collecting system.

Application of the saphenous nerve emerging site through the adductor canal in ultrasound-guided adductor canal block / 临床麻醉学杂志

Objective To study clinical data retrospectively and demonstrate the optimal injection site of adductor canal block by performing a cadaveric study.Methods Clinical part:clinical data from 19 patients,11 males and 8 females,aged 21 85 years,ASA physical status Ⅰ-Ⅲ,who received ultrasound guided adductor canal block were retrospectively collected.Among whom 9 received a mid-distance injection of 10 ml of 0.5％ ropivacaine and 10 received an injection of the same medication at the outlet of adductor canal.The primary endpoint was complete absence of cold sensation to ice cube on the medial side of calf at 30 minutes and 24 hours after injection.Cadaveric part:40 lower limbs,20 males and 20 females,were finally analyzed in the study.The distances from the anterior superior iliac spine (ASIS) to the medial tibial condyle,from ASIS to the entrance of the adductor canal,from ASIS to the exit of the canal (adductor tendinous opening),from ASIS to the site where sa phenous nerve emerges through the aponeurotic covering were measured respectively.The length of adductor canal,the relative location of adductor canal and the site where saphenous nerve pierces in the lower limbs were calculated.Results Clinical part:all 19 cases were successfully recorded with complete absence of cold sensation at 30 minutes after injection of local anesthetic and complete sensory recovery at 24 hours after injection.Cadaveric part:in all specimens,saphenous nerve enters adductor canal and coursed down until emerging at very close to the distal end of the canal with the saphenous branch of descending genicular artery.The length of the adductor canal was (10.0±2.1) cm.The entrance and the exit of adductor canal and the emerging site of the saphenous nerve located along the (54.7±3.0) ％,(76.0％±3.8) ％ and (74.1±3.2) ％ of sartorius muscle,respectively.Conclusion Performing ultrasound-guided adductor canal block at either the outlet of adductor canal or mid-distance of thigh can achieve comparable blockade of saphenous nerve.Cadaveric study implicated that the optimal injection site for adductor canal block should be the lower one-third of sartorius muscle.Ultrasound-guided injection of local anesthetics next to the descending genicular artery may possibly become a promising new method of saphenous nerve block.

Perioperative regional pain management of TKA / 基础医学与临床

Perioperative pain management play a critical role in rapid recovery and long term outcome in patient undergoing total knee arthroplasty.With the advancement of peripheral nerve block, technique such as femoral nerve block, sciatic nerve block, abductor canal block have play an important role in perioperative pain management.Local infiltration analgesia have also gained popularity.The ultimate goal of perioperative pain management is to ensure analgesia effect and maintain good motor function of lower extremity.We are still in searching of a safe, effective, analgesia without motor block.Currently multimodal analgesia seems to be the most favorable choice.

Effects of dexmedetomidine on the emergence of patients undergoing transnasal transsphenoidal pituitary tumor resection / 临床麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on the tolerance to endotracheal tube, on agitation and other complications of patients undergoing transnasal transsphenoidal pituitary tumor resection.Methods One hundred and twenty-four patients aged 18-65 years, ASA physical status Ⅰ or Ⅱ) were randomly assigned to dexmedetomidine group (group D, n=60) and control group (group C, n=62).Group D were given intravenous infusion of dexmedetomidine during the operation and group C with saline.The extubation time, observation time in the post-anesthesia care unit (PACU), the incidence of emergence agitation, cough, postoperative sore throat and hoarseness were analyzed.Results The extubation time [(29.7±11.5) min vs (22.2±8.5) min] and the length of stay in PACU [(41.5±11.8) min vs (35.3±10.0) min] were significantly longer in group D than those in group C (P<0.05).There was no significant difference of the incidence of emergence agitation (26.3% vs 32.3%), cough (49.1% vs 53.2%), postoperative sore throat (14.0% vs 24.2%) and hoarseness (10.5% vs 19.4%) between two groups.Conclusion Intraoperative intravenous administration of dexmedetomidine can prolong the extubation time and the length of stay in PACU.The incidence of agitation, cough, postoperative sore throat and hoarseness was not affected by dexmedetomidine.

Tetrahydroisoquinolines as novel histone deacetylase inhibitors for treatment of cancer

Histone acetylation is a critical process in the regulation of chromatin structure and gene expression. Histone deacetylases (HDACs) remove the acetyl group, leading to chromatin condensation and transcriptional repression. HDAC inhibitors are considered a new class of anticancer agents and have been shown to alter gene transcription and exert antitumor effects. This paper describes our work on the structural determination and structure-activity relationship (SAR) optimization of tetrahydroisoquinoline compounds as HDAC inhibitors. These compounds were tested for their ability to inhibit HDAC 1, 3, 6 and for their ability to inhibit the proliferation of a panel of cancer cell lines. Among these, compound 82 showed the greatest inhibitory activity toward HDAC 1, 3, 6 and strongly inhibited growth of the cancer cell lines, with results clearly superior to those of the reference compound, vorinostat (SAHA). Compound 82 increased the acetylation of histones H3, H4 and tubulin in a concentration-dependent manner, suggesting that it is a broad inhibitor of HDACs.

Laparoscopic-assisted vaginoplasty by using sigmoid colon and peritoneum for congenital complete colpatresia / 局解手术学杂志

Objective To study the desired therapeutic effect of vaginoplasty using sigmoid colon or peritoneum for entire vaginal atre-sia.Methods From May 2015 to October 2015,8 patients with complete vaginal atresia in our hospital performed vaginoplasty using sigmoid colon or peritoneum successfully.The operation methods,prognosis and therapeutic effect and quality of sexual life of two groups were com-pared and analyzed to investigate a perfect operative method and ideal nursing.Results Laparoscopic vaginoplasty using the peritoneum compared with that using sigmoid colon has advantages of shorter time of operation,less bleeding,less trauma and quicker recovery.However, artificial vagina using sigmoid colon was much more similar to a natural vagina in morphological and physiological characteristics,merely ac-companied by excessive mucus discharge during the postoperative period.At lower risk of vaginal adhesion and stenosis,laparoscopically as-sisted vaginoplasty using sigmoid colon graft also puts high technical requirements.Two patients normally developed uterus menstruate regular-ly.Four patients without uterus and 2 patients with rudimentary uterus experienced good sexual intercourse after vaginoplasty.Conclusion Patients with complete colpatresia who have normal womb should creat a patent and functional vagina until adolescence to restore its physio-logical and reproductive function.Anatomical reconstructive treatment of vaginal agenesis for patients with absent or hypoplastic uterus can be postponed till the late teens or in the adult.Both laparoscopic sigmoid vaginoplasty and peritoneal vaginoplasty achieve a minimal-invasive, cosmetic,natural lubricous, smooth artificial vagina for patient’ s sex life satisfactory.

Comparison of Effects of Different Doses Dexmedetomidine on Inhibiting Tracheal Intubation-Evoked Haemodynamic Response in the Elderly Patients.

BACKGROUND: Dexmedetomidine (DEX) is a selective α2-adrenergic receptor agonist with anxiolytic and analgesic properties. In the present study, we aimed primarily to assess the effects of DEX on sedation, cognitive function and cardiovascular reflex responses before, during and after the tracheal intubation in the elderly patients. MATERIALS AND METHODS: Eighty patients undergoing elective abdominal surgery were randomly assigned to four Groups: Group A(saline, n=20), Group B (0.25µg/kg DEX, n=20), Group C (0.50µg/kg DEX, n=20) and Group D (1.00µg/kg DEX, n=20). With the constant speed infusion of saline and a loading different doses of DEX (diluted with saline to 50ml) for 10min respectively before induction of anaesthesia, the values of arterial pressure {systolic blood pressure (SBP), diastolic blood pressure (DBP)}, heart rate (HR) and bispectral index (BIS) at the time point of before pump DEX (T0), at the end of infusing DEX (T1), before tracheal intubation (T2), at the moment of tracheal intubation (T3) and 5min after trachea intubation (T4) were observed, oxygen saturation (SPO2) and the Modified Observers Assessment of Alertness/Sedation Scale (OAA/S) score were observed at the time of T1 and T0. RESULTS: Comparison among Groups, compared with Group A, SBP and DBP values in Group C at T2 showed significant differences (p<0.05), SBP and DBP values in Group D at T1, T2 and T4 indicated significant differences (p<0.05), HR values in Group D at T1, T2, T3 and T4 showed significant differences (p<0.05); Compared with Group A, BIS values in Group C at T2 and T3 indicated significant differences (p<0.05), BIS values in Group D at T1, T2, T3 and T4 showed significant differences (p<0.05); Comparison between T3 andT2, means of SBP, DBP and HR in Group A and in Group B showed significant differences (p<0.05); Group D showed significant differences in SPO2 and (OAA/S) betweenT1 and T0 (p<0.05). CONCLUSION: Comparison within Groups and between Groups in different doses DEX, the present result showed that 0.5µg/kg DEX had an effective inhibition, without respiratory depression, on tracheal intubation evoked cardiovascular response in the elderly patients.

Effect of ulinastatin on liver function of patients after bilateral total knee arthroplasty / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effect of ulinastatin, a urinary trypsin inhibitor, on the postoperative liver function in patients who have received bilateral total knee arthroplasty (TKA) under pneumatic tourniquet.</p><p><b>METHODS</b>Totally 40 patients who were scheduled to receive bilateral TKA under thigh tourniquet were randomly assigned into trial group (U group, receiving intravenous ulinastatin) and control group (C group, receiving natural saline). All patients received the same general anesthesia and postoperative analgesia. The plasma concentrations of alanine transaminase (ALT), total bilirubin (TBil), and direct bilirubin (DBil) were recorded and compared preoperatively and 4, 24, 48, and 72 hours after the surgery.</p><p><b>RESULTS</b>The demographic data were not significantly different between these two groups (P>0.05). The ALT was not significantly changed after the surgery in the C group (P>0.05) but was significantly decreased 48 hours (P=0.002) and 72 hours (P=0.001) after the surgery in the U group. TBil and DBil were significantly increased 48 hours (P=0.012, P=0.000) and 72 hours (P=0.000, P=0.000) after the surgery in C group, while only that at 48 hours (P=0.010, P=0.038) was significantly increased in the U group. ALT 4 hours (P=0.026), 48 hours (P=0.013), 72 hours (P=0.004) after the surgery were significantly lower in the U group than those in C group. TBil at the 72 hours postoperatively in U group was significantly lower than that in C group (P=0.036). DBil was not significantly different between C group and U group at all time points (all P>0.05).</p><p><b>CONCLUSION</b>The application of ulinastatin in bilateral TKA can protect postoperative liver function.</p>

Accuracy of positron emission tomography/computed tomography in the diagnosis and restaging for recurrent ovarian cancer: a meta-analysis.

OBJECTIVE: A meta-analysis was performed to estimate the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) in suspected recurrent ovarian cancer. MATERIALS AND METHODS: PubMed, The Cochrane Library, Embase, and Web of Science were systematically searched. Studies that compared PET/CT and reference standards within patients for diagnosis of suspected recurrent ovarian cancer were included. RESULTS: Twenty-nine studies involving 1651 patients with ovarian cancer were analyzed. For recurrent versus nonrecurrent ovarian cancer, the pooled sensitivity, specificity, positive likelihood (LH) ratio, negative LH ratio, and diagnostic odds ratio of ovarian carcinoma were 88.6% (95% confidence interval [CI], 86.6%-90.3%), 90.3% (95% CI, 87.6%-92.7%), 6.104 (95% CI, 3.904-9.543), 0.122 (95% CI, 0.077%-0.192%), and 57.032 (95% CI, 30.764-105.73), respectively, for recurrence in the PET/CT. Because sensitivity, specificity, positive LH ratio, and negative LH ratio were all heterogeneous, random effects model was used, and a summary receiver operating characteristic curve was generated. The area under the curve was 0.9445 for recurrent versus nonrecurrent ovarian cancer. CONCLUSIONS: Positron emission tomography/computed tomography is a useful tool for predicting the diagnosis and restaging of suspected recurrent ovarian carcinoma.