Miao medicinal crossbow acupuncture therapy as adjuvant treatment for lung cancer pain: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of Miao medicinal crossbow acupuncture therapy as adjuvant treatment for lung cancer pain based on oxycodone hydrochloride extended-release tablet.@*METHODS@#A total of 60 patients with lung cancer pain were randomized into an observation group (30 cases, 1 case dropped off) and a control group (30 cases). In the control group, oxycodone hydrochloride extended-release tablet was given orally, 10 mg a time, once every 12 hours. On the basis of the treatment in the control group, Miao medicinal crossbow acupuncture therapy was applied once every other day in the observation group. The treatment of 14 days was required in the two groups. Before and after treatment, the numerical rating scale (NRS) score, number of break-out pain and Karnofsky performance status (KPS) score were observed in the two groups. The equivalent oxycodone consumption and rate of adverse reactions were recorded, the analgesic effect was evaluated in the two groups.@*RESULTS@#Compared before treatment, the NRS scores and number of break-out pain were decreased while the KPS scores were increased after treatment in the two groups (P<0.01). After treatment, the NRS score and number of break-out pain in the observation group were lower than the control group (P<0.01), the KPS score in the observation group was higher than the control group (P<0.05). The equivalent oxycodone consumption of whole course and the rate of adverse reactions i.e. constipation, drowsiness, nausea and vomiting in the observation group were lower than the control group (P<0.05). The analgesic effect rate was 93.1% (27/29) in the observation group, which was superior to 63.3% (19/30) in the control group (P<0.05).@*CONCLUSION@#On the basis of oxycodone hydrochloride extended-release tablet, Miao medicinal crossbow acupuncture therapy as adjuvant treatment can effectively relieve the pain degree, reduce the number of break-out pain and improve the health status and quality of life in patients with lung cancer pain, enhance the efficacy of medication and reduce its adverse reactions.

Effect of beinaglutide treatment on weight loss in Chinese patients with type 2 diabetes mellitus and overweight/obesity

ABSTRACT Objective: To evaluate the effect of beinaglutide on weight loss and plasma protein patterns of inflammation/obesity relevant cytokines and biomarkers. Materials and methods: This study involved 36 adult patients with a body mass index (BMI) of ≥ 24 kg/m2 and T2DM. Beinaglutide was administered for three months. Changes in body weight, fasting plasma glucose (FPG) level, 2 h postprandial plasma glucose (2h-PG) level, glycosylated hemoglobin (HbA1c) level, BMI and visceral and subcutaneous fat areas were measured at baseline and after three months of treatment. In addition, relevant inflammation/obesity cytokines and biomarkers were measured. Results: After three months, beinaglutide treatment led to significant changes, including in body weight, BMI, FPG level, HbA1c level, visceral and subcutaneous fat areas. In addition, serpin E1, leptin, C-reaction protein (CRP) and tumor necrosis factor-α (TNF-α) also decreased significantly. The plasma protein concentrations of CRP (Log2 transformed) were found to be positively correlated with the percentage of weight loss (R = 0.514 and p-value = 0.021). Conclusion: Beinaglutide treatment resulted in weight loss, plasma glucose control and anti-inflammatory effects in patients with T2DM and overweight/obesity.

Epidural block associated with improved long-term survival after surgery for colorectal cancer: A retrospective cohort study with propensity score matching / 北京大学学报(医学版)

OBJECTIVE@#To investigate the effect of epidural anesthesia on the long-term prognosis of patients after selective colorectal cancer resection surgery.@*METHODS@#This was a retrospective cohort study and approved by local institution review board. Patients who underwent selective colorectal cancer resection surgery from August 2011 to December 2012 in Peking University First Hospital were enrolled. The patients were divided into general anesthesia (GA) group and combined epidural-general anesthesia (EGA) group according to anesthesia type. Primary outcome was patient's long-term survival status. Secondary outcome included the overall incidence of in-hospital complications and length of postoperative in-hospital stay. Propensity score was used to match cases between the two groups based on the probability of receiving EGA. Survival was analyzed by Kaplan-Meier analysis and compared by Log-rank test between the two groups. Multivariate Cox regression analysis was used to investigate the relationship between epidural anesthesia and other variables with long-term survival status.@*RESULTS@#A total of 264 patients were entered into final analysis, including 166 cases in GA group and 98 cases in EGA group. Mean age of the patients was (63.3±12.1) years and mean survival time was 47.2 (95%CI 45.7-48.7) months. Before the propensity score match, the mortality in EGA group was 16.9% (28/166) and 9.2% (9/98) in GA group. But comparison between the two groups had no statistical significance (P=0.091). After the propensity score match, 87 paired cases were matched and analyzed. The risk of long-term mortality in EGA group was lower than that of GA group by Kaplan-Meier analysis (5.7% vs.16.1%, HR=0.344, 95%CI 0.124-0.955, P=0.041). Mean survival time of EGA group was longer than that of GA group (50.3 months vs. 42.9 months, P=0.032). Multivariate Cox regression ana-lysis showed that EGA, in comparison with GA, was related with lower risk of long-term mortality (HR=0.326, 95%CI 0.117-0.909, P=0.032). Age (HR=1.042, 95%CI 1.001-1.085, P=0.046) and preoperative lymph node metastasis (HR=2.924, 95%CI 1.162-7.356, P=0.023) were also related with increased risk of long-term mortality.@*CONCLUSION@#Present study found that perioperative use of epidural anesthesia and analgesia was associated with improvement of the patient's long-term survival. Well-designed studies are needed to verify this hypothesis.

Comparison of pulse pressure variation, stroke volume variation, and plethysmographic variability index in pediatric patients undergoing craniotomy / 北京大学学报(医学版)

OBJECTIVE@#To compare well-known preload dynamic parameters intraoperatively including stroke volume variation (SVV), pulse pressure variation (PPV), and plethysmographic variability index (PVI) in children who underwent craniotomy for epileptogenic lesion excision.@*METHODS@#A total of 30 children aged 0 to 14 years undergoing craniotomy for intracranial epileptogenic lesion excision were enrolled. During surgery, we measured PPV, SVV (measured by the Flotrac/Vigileo device), and PVI (measured by the Masimo Radical-7 monitor) simultaneously and continuously. Preload dynamic parameter measurements were collected at predefined steps: after induction of anesthesia, during opening the skull, intraoperative electroencephalogram monitoring, excision of epileptogenic lesion, skull closure, at the end of the operation. After exclusion of outliers, agreement among SVV, PPV, and PVI was assessed using repeated measures of Bland-Altman approach. The 4-quadrant and polar plot techniques were used to assess the trending ability among the changes in the three parameters.@*RESULTS@#The mean SVV, PPV, and PVI were 8%±2%, 10%±3%, and 15%±7%, respectively during surgery. We analyzed a total of 834 paired measurements (3 to 8 data sets for each phase per patient). Repeated measures Bland-Altman analysis identified a bias of -2.3 and 95% confidence intervals between -1.9 and -2.7 (95% limits of agreement between -6.0 and 1.5) between PPV and SVV, showing significant correlation at all periods. The bias between PPV and PVI was -5.0 with 95% limits of agreement between -20.5 and 10.5, and that between SVV and PVI was -7.5 with 95% limits of agreement between -22.7 and 7.8, both not showing significant correlation. Reflected by 4-quadrant plots, the con-cordance rates showing the trending ability between the changes in PPV and SVV, PPV and PVI, SVV and PVI were 88.6%, 50.4%, and 50.1%, respectively. The concordance rate between PPV and SVV was higher (92.7%) in children aged less than 3 years compared with those aged 3 and more than 3 years. The mean angular bias, radial limits of agreement, and angular concordance rate in the polar analysis were not clinically acceptable in the changes between arterial pressure waveform-based parameters and volume-based PVI (PPV vs. PVI: angular mean bias 8.4°, angular concordance rate 29.9%; SVV vs. PVI: angular mean bias 2.4°, angular concordance rate 29.1%). There was a high concordance between the two arterial pressure waveform-based parameters reflected by the polar plot (angular mean bias -0.22°, angular concordance rate 86.6%).@*CONCLUSION@#PPV can be viewed as a surrogate for SVV, especially in children aged less than 3 years. The agreement between arterial pressure waveform-based preload parameters (PPV and SVV) and PVI is poor and these two should not be considered interchangeable. Attempt to combine PVI and PPV for improving the anesthesiologist's ability to monitor cardiac preload in major pediatric surgery is warranted.

Evaluation of Multidrug Resistant Loop-mediated Isothermal Amplification Assay for Detecting the Drug Resistance of / 生物医学与环境科学（英文）

Objective@#To evaluate multidrug resistant loop-mediated isothermal amplification (MDR-LAMP) assay for the early diagnosis of multidrug-resistant tuberculosis and to compare the mutation patterns associated with the @*Methods@#MDR-LAMP assay was evaluated using 100 @*Results@#The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDR-LAMP were 85.5%, 93.6%, 96.7%, and 74.4% for the detection of resistance to isoniazid and rifampicin, respectively, and 80.5%, 92.3%, 98.6%, and 41.4% for the detection of @*Conclusion@#MDR-LAMP is a rapid and accessible assay for the laboratory identification of rifampicin and isoniazid resistance of

Clinical outcomes of vocal fold immobility after tracheal intubation / 北京大学学报(医学版)

OBJECTIVE@#To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.@*METHODS@#We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.@*RESULTS@#A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.@*CONCLUSION@#Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.

Oral health status in elderly residents in Songjiang District of Shanghai / 上海预防医学

Objective To understand oral health of the elderly in nursing home in Songjiang District, Shanghai, and to provide references for improving their oral health. Methods A total of 375 elderly people in 15 nursing homes in Songjiang District were investigated by questionnaires and oral examination.Tooth loss, denture repair, periodontal condition and oral hygiene habit were analyzed. Results The rate of the tooth loss reached 94.13%.The tooth loss rate in females (96.09%) was significantly higher than that in males (91.03%) (P < 0.01).The rate of complete edentulous jaws was 28.27%.There was a significant difference between the rate of complete edentulous jaws in females (34.35%) and in males (18.62%)(P < 0.05).The rate of denture restoration was 91.51% (97/106).The number of existing teeth per capita was 11.54, and the number of teeth per capita in males (14.48 per person) was significantly higher than that in females (9.70 per person) (P < 0.05).Both the rate of the tooth loss of upper and lower posterior teeth were significantly higher than that of upper and lower anterior teeth (P < 0.01).Thirty-three percent (33.33%) of the elderly brushed their teeth more than twice a day, and almost 20.53% of them didn′t brush their teeth. Conclusion The oral health of the elderly in the nursing homes in Songjiang District is not satisfactory at present.It is necessary to strengthen the publicity and education of oral health care for the elderly in nursing homes in cooperation with multiple departments to improve their awareness of oral health care including appropriate tooth repair for the quality of life.

Analysis on mechanism of Yaotongning Capsule in treatment of lumbar intervertebral disc herniation / 中草药

Lumbago disease is a common disease, which mainly manifested as acute or chronic pain in the lumbar spine or paraspinal region, mainly represented by lumbar disc herniation in clinical practice. The new drug, Yaotongning Capsule with better efficacy for lumbago in clinic, is made of Strychni Semen Pulveratum, Eupolyphaga Steleophaga, Cyathulae Radix, Glycyrrhizae Radix et Rhizoma, Ephedrae Herba, Olibanum and Myrrh (prepared with vinegar), scorpion, Bombyx Batryticatus (bran fried), and Atractylodis Rhizoma (bran fried). This paper analyzes the etiology and pathogenesis of lumbar intervertebral disc herniation through traditional Chinese medicine, and explores the mechanism of treating lumbar intervertebral disc herniation with Yaotongning Capsule from the perspective of prescription theory, so as to provide theoretical basis for clinical application of Yaotongning Capsule.

Potential impact of epidural labor analgesia on the outcomes of neonates and children / 中华医学杂志(英文版)

This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including "ELA," "ELA and neonatal outcomes," "ELA and children's development," and "ELA and children's neurocognitive development" were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.

Anti-cancer Mechanism of Polygonati Rhizoma-Lilii Bulbus Based on Network Pharmacology / 中国实验方剂学杂志

Objective::To screen out active ingredients of Polygonati Rhizoma-Lilii Bulbus, and predict the targets and signaling pathways, in order to explore the potential mechanism in treatment of cancer by using network pharmacology. Method::All of active ingredients and targets of Polygonati Rhizoma-Lilii Bulbus were screened out through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). Disease targets for cancer were collected through databases of gene-disease associations (DisGeNET) and Online Mendelian Inheritance in Man (OMIM). Then the Omicshare platform was used to match the active ingredients and the targets for treating cancer. And the " drug-active ingredients-disease targets" network was established using Cytoscape 3.7.0 software. The functional protein association networks (String) database was used to construct the protein interaction network of drug pair targets for treating cancer. Finally, the Functional Annotation Bioinformatics Microarray Analysis (DAVID) database was used to analyze the biological functions and metabolic pathways of key targets. Result::A total of 19 active ingredients were screened out, 234 targets were predicted, 6 active ingredients were identified to be related to cancer. The anti-cancer effect was mainly correlated with the regulation of target proteins in treating cancer, such as Akt serine/threonine kinase 1 (Akt1), Jun proto-oncogene, AP-1 transcription factor subunit (JUN), vascular endothelial growth factor A (VEGFA), matrix metallopeptidase-9 (MMP-9), Caspase-3, Fos proto-oncogene, AP-1 transcription factor subunit (FOS), proteoglycans in cancer, estrogen signaling pathway, human immunodeficiency virus 1 infection, hypoxia inducible factor-1 (HIF-1) signaling pathway, tumor necrosis factor(TNF) signaling pathway, microRNAs in cancer and other pathways. Conclusion::The anti-cancer effect of Polygonati Rhizoma-Lilii Bulbus reflects multi-component, multi-target, multi-pathway characteristics of TCM, and provides a scientific basis for explaining the mechanism and material basis of anti-cancer treatment.

Application of valvuloplasty in mitral valve insufficiency in infants and small children / 中华实用儿科临床杂志

Objective@#To explore the efficacy of valvuloplasty on mitral valve regurgitation (MR) in infants and small children, in order to provide evidence for clinical treatment.@*Methods@#Retrospective analysis was conducted in patients aged less than 3 years old who have undergone mitral repair surgeries at Department of Cardiovascular Surgery, General Hospital of Western Theater Command from January 2015 to December 2017.Cardiopulmonary bypass (CPB) surgery was performed under general anesthesia.The corresponding repair operations were selected for various MR types.All the children were examined by cardiac ultrasound before discharge.Patients were followed up after surgery and mitral regurgitation was recorded.@*Results@#A total of 69 patients were enrolled, including 30 boys and 39 girls, with an average age of (19.3±11.6) months and an average weight of (9.6±2.1) kg.There were 32 cases of Carpentier type Ⅰ, 30 cases of type Ⅱ and 7 cases of type Ⅲ.Twenty-nine patients were diagnosed as simple MR, while the other 40 patients were combined with other cardiac malformations.One patient died at postoperative day 7.One patient still had severe MR after surgery, and then second operation was performed on the 10th day after first surgery.Sixty-five patients were followed up from 1 month to 3 years[(15.9±10.9) months]. During the follow-up period, no patient died or had reoperation.Aggravated MR was observed in 4 patients.@*Conclusions@#Mitral valvuloplasty is a safe and effective surgical method for treating infants and younger children with MR.The key to the success of surgery is to choose the appropriate individualized repair operation.At the same time, the growth potential of mitral valve should be fully considered to avoid restrained development.

Medical Knowledge Extraction and Analysis from Electronic Medical Records Using Deep Learning / 中国医学科学杂志(英文版)

Objectives Medical knowledge extraction (MKE) plays a key role in natural language processing (NLP) research in electronic medical records (EMR), which are the important digital carriers for recording medical activities of patients. Named entity recognition (NER) and medical relation extraction (MRE) are two basic tasks of MKE. This study aims to improve the recognition accuracy of these two tasks by exploring deep learning methods. Methods This study discussed and built two application scenes of bidirectional long short-term memory combined conditional random field (BiLSTM-CRF) model for NER and MRE tasks. In the data preprocessing of both tasks, a GloVe word embedding model was used to vectorize words. In the NER task, a sequence labeling strategy was used to classify each word tag by the joint probability distribution through the CRF layer. In the MRE task, the medical entity relation category was predicted by transforming the classification problem of a single entity into a sequence classification problem and linking the feature combinations between entities also through the CRF layer. Results Through the validation on the I2B2 2010 public dataset, the BiLSTM-CRF models built in this study got much better results than the baseline methods in the two tasks, where the F1-measure was up to 0.88 in NER task and 0.78 in MRE task. Moreover, the model converged faster and avoided problems such as overfitting. Conclusion This study proved the good performance of deep learning on medical knowledge extraction. It also verified the feasibility of the BiLSTM-CRF model in different application scenarios, laying the foundation for the subsequent work in the EMR field.

Application of valvuloplasty in mitral valve insufficiency in infants and small children / 中华实用儿科临床杂志

Objective To explore the efficacy of valvuloplasty on mitral valve regurgitation (MR) in infants and small children,in order to provide evidence for clinical treatment.Methods Retrospective analysis was conducted in patients aged less than 3 years old who have undergone mitral repair surgeries at Department of Cardiovascular Surgery,General Hospital of Western Theater Command from January 2015 to December 2017.Cardiopulmonary bypass (CPB) surgery was performed under general anesthesia.The corresponding repair operations were selected for various MR types.All the children were examined by cardiac ultrasound before discharge.Patients were followed up after surgery and mitral regurgitation was recorded.Results A total of 69 patients were enrolled,including 30 boys and 39 girls,with an average age of (19.3 ± 11.6) months and an average weight of (9.6 ±2.1) kg.There were 32 cases of Carpentier type Ⅰ,30 cases of type Ⅱ and 7 cases of type Ⅲ.Twenty-nine patients were diagnosed as simple MR,while the other 40 patients were combined with other cardiac malformations.One patient died at postoperative day 7.One patient still had severe MR after surgery,and then second operation was performed on the 10th day after first surgery.Sixty-five patients were followed up from 1 month to 3 years[(15.9 ± 10.9) months].During the follow-up period,no patient died or had reoperation.Aggravated MR was observed in 4 patients.Conclusions Mitral valvuloplasty is a safe and effective surgical method for treating infants and younger children with MR.The key to the success of surgery is to choose the appropriate individualized repair operation.At the same time,the growth potential of mitral valve should be fully considered to avoid restrained development.

Study on Medication Rules of TCM Master LIU Shang-yi for Treatment of Hepatocarcinoma / 中国中医药信息杂志

Objective To explore the medication features of Professor LIU Shang-yi for the treatment of hepatocarcinoma; To provide references for the clinic. Methods Medical cases about hepatocarcinoma treated by Professor LIU Shang-yi in National Medical Center Clinic of Guizhou Provincial TCM Hospital from March 2014 to August 2016 were collected. TCM inheritance support platform software V2.5 was used to analyze properties and flavors, frequency, compatibility law and core medicine combinations. Results Totally 318 prescriptions were included in the study, involving 137 kinds of Chinese materia medica and frequency of 2931 times. The medicines with high frequency were Curcumae Rhizoma, vinegar Trionycis Carapax, Rabdosiae Rubescentis Herba, Ranunculi Ternati Radix and Hypericum Japonicum Thunb; cold and warm were used in the prescriptions, and there were a lot of medicines with flavors of spicy, bitter and sweet. 68 groups of two medicines, 100 groups of three medicines and 72 groups of four medicines with high frequency were obtained by data mining. High frequency association rules were"Curcumae Rhizoma - vinegar Trionycis Carapax", "Curcumae Rhizoma - Rabdosiae Rubescentis Herba", "vinegar Trionycis Carapax - Rabdosiae Rubescentis Herba". Conclusion The prescriptions for the treatment of hepatocarcinoma by Professor LIU Shang-yi have the efficacy of tonifying yin, and resolving masses, clearing heat and detoxifying, which shows the treatment principles of strengthening body resistance and eliminating evil, and adjusting yin and yang.

Relationship between preoperative abnormal echocardiography and occurrence of postoperative major adverse cardiac events in non-cardiac surgery patients: A nested case-control study / 解放军医学杂志

Objective To investigate the relationship between preoperative abnormal transthoracic echocardiogram (TTE) and postoperative major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery.Methods This study was a nested case control study.Patients who underwent elective non-cardiac surgery in Peking University First Hospital from November 15,2012 to January 15,2013 were enrolled.We screened patients who received preoperative TTE examination from electrical medical record.The primary outcome of this study was the incidence of postoperative MACEs.The patients were divided into MACE group and control group depending on if they suffered MACE.For each patient in MACE group,4 patients without MACE events were selected for control group in term of two criteria:same revised cardiac risk index and same type of surgery.Related perioperative data were collected.Multivariate logistic analysis was used for screening potential risk factors related to MACE.Results During the study period,a total of 2975 patients undergoing elective surgery,2081 met the inclusion criteria.Amongst these patients,530 patients received preoperative TTE examinations and 25 suffered postoperative MACEs.Overall incidence of TTE abnormalities was 91.9％(487/530).25 patients with MACE and 100 patients without MACE (as control group) were selected for case control analysis.The incidence of TTE abnormality was about 92.0％ (23/25) in MACE group and 93.0％(93/100) in control group (OR=0.866,95％CI 0.169-4.446,P=1.000).Multivariate logistic analysis showed that left ventricular hypertrophy was an independent risk of MACE (OR=4.324,95％CI 1.320-14.160,P=0.016),female(OR=4.782,95％CI 1.636-13.980,P=0.005) and history of chronic renal failure (OR=21.952,95％CI 1.547-311.475,P=0.016) were also related with MACE.The predictive value of preoperative TTE abnormality against MACE was very low in ROC analysis (AUC=0.501,P=0.992).Conclusions Left ventricular hypertrophy is related to increased risk of postoperative MACE.However,further studies are needed to confirm the value of TTE examination as a routine examination for cardiac evaluation before surgery.

Knockdown Inhibits the Proliferation, Invasiveness, and Metastasis of Hepatocellular Carcinoma Cells and Sensitizes them to TRAIL-Induced Apoptosis / 中华医学杂志(英文版)

<p><b>Background</b>XB130 is a recently discovered adaptor protein that is highly expressed in many malignant tumors, but few studies have investigated its role in hepatocellular carcinoma (HCC). Therefore, this study explored the relationship between this protein and liver cancer and investigated its molecular mechanism of action.</p><p><b>Methods</b>The expression of XB130 between HCC tissues and adjacent nontumor tissues was compared by real-time polymerase chain reaction, immunochemistry, and Western blotting. XB130 silencing was performed using small hairpin RNA. The effect of silencing XB130 was examined using Cell Counting Kit-8, colony assay, wound healing assay, and cell cycle analysis.</p><p><b>Results</b>We found that XB130 was highly expressed in HCC tissues (cancer tissues vs. adjacent tissues: 0.23 ± 0.02 vs. 0.17 ± 0.02, P < 0.05) and liver cancer cell lines, particularly MHCC97H and HepG2 (MHCC97H and HepG2 vs. normal liver cell line LO-2: 2.35 ± 0.26 and 2.04 ± 0.04 vs. 1.00 ± 0.04, respectively, all P < 0.05). The Cell Counting Kit-8 assay, colony formation assay, and xenograft model in nude mice showed that silencing XB130 inhibited cell proliferative ability both in vivo and in vitro, with flow cytometry demonstrating that the cells were arrested in the G0/G1 phase in HepG2 (HepG2 XB130-silenced group [shA] vs. HepG2 scramble group [NA]: 74.32 ± 5.86% vs. 60.21 ± 3.07%, P < 0.05) and that the number of G2/M phase cells was decreased (HepG2 shA vs. HepG2 NA: 8.06 ± 2.41% vs. 18.36 ± 4.42%, P < 0.05). Furthermore, the cell invasion and migration abilities were impaired, and the levels of the epithelial-mesenchymal transition-related indicators vimentin and N-cadherin were decreased, although the level of E-cadherin was increased after silencing XB130. Western blotting showed that the levels of phosphorylated phosphoinositide 3-kinase (PI3K) and phospho-protein kinase B (p-Akt) also increased, although the level of phosphorylated phosphatase and tensin homolog increased, indicating that XB130 activated the PI3K/Akt pathway. Furthermore, we found that a reduction in XB130 increased liver cancer cell sensitivity to tumor necrosis factor-related apoptosis-inducing ligand-induced apoptosis.</p><p><b>Conclusions</b>Our findings suggest that XB130 might be used as a predictor of liver cancer as well as one of the targets for its treatment.</p>

Anti-apoptosis Effect of Decoy Receptor 3 in Cholangiocarcinoma Cell Line TFK-1 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Decoy receptor 3 (DcR3) is a protein with anti-apoptotic effect that belongs to the tumor necrosis factor receptor superfamily. DcR3 is highly expressed in a variety of malignant tumors including cholangiocarcinoma and its expression was found to be related to the clinical stage, the invasion, and the metastasis of the tumor. This in vitro study aimed to investigate the effect of downregulated expression of DcR3 on cell viability, cell apoptosis, and cell cycle in cholangiocarcinoma cell line TFK-1.</p><p><b>METHODS</b>Three different cell lines were cultured: human cholangiocarcinoma TFK-1, human biliary epithelial carcinoma HuCCT-1, and human cholangiocarcinoma RBE. The cholangiocarcinoma cell line with the highest expression of DcR3 was selected for further investigation. The expression of DcR3 was silenced/knocked down by transfection with DcR3-siRNA in the selected cell line. Various biological phenotype parameters such as cell viability, apoptosis, and cell cycle were observed.</p><p><b>RESULTS</b>The mRNA and protein levels of DcR3 were measured in the three cell lines, and TFK-1 was selected. After the treatment with DcR3-siRNA for 48 h, DcR3 mRNA and protein expression in the treatment group were 38.45% (P < 0.01) and 48.03% (P < 0.05) of that of the control, respectively. It was found that the cell viability decreased to 61.87% of the control group (P < 0.01) after the downregulation of DcR3 in cholangiocarcinoma cell line TFK-1 by transfection with DcR3-siRNA, while the percentage of apoptotic cells was 2.98 times as compared with the control group (P < 0.05). Compared with the control group the ratio of G0/G1increased, and the ratio of G2/M decreased in the treatment group. However, the differences were not statistically significant.</p><p><b>CONCLUSIONS</b>The effect of DcR3 on the growth and apoptosis of cholangiocarcinoma has been demonstrated. DcR3 is not only a predictive marker for malignant tumor but it is also likely to be a potential target for cancer gene therapy. Further studies should focus on exploring the binding ligand of DcR3, the signaling pathway involved, and the molecular mechanism for the regulation of DcR3 expression in cholangiocarcinoma.</p>

Perioperative management of pregnant women combined with congenital fibrinogen deficiency: four cases report and literature review / 北京大学学报(医学版)

Congenital fibrinogen deficiency is an autosomal recessive or dominant disorder in which quantitative (afibrinogenaemia or hypofibrinogenaemia) or qualitative (dysfibrinogenaemia) defects in the fibrinogen Aa, Bb or c protein chains that lead to reduced functional fibrinogen. We now report the perioperative management of 4 pregnant women suffering from hypofibrinogenaemia scheduled for elective caesarean section from December 2012 to October 2016 in Peking University First Hospital and review this disease with reference to classification, symptom, replacement therapy, and selection of the modes of pregnancy termination and anesthesia. The four patients were all asymptomatic, whereas there existed recurrent pregnancy loss (case 3), family history (case 2), and offspring heredity (cases 3 and 4). Routine clotting studies revealed low fibrinogen levels and prolonged thrombin time (TT) during pregnancy and on admission. However, the platelet (PLT) count, prothrombin time (PT) and activated partial thromboplastin time (APTT) were normal. All the patients were administered fibrinogen concentrate perioperatively, and underwent uncomplicated combined spinal-epidural anesthesia and uneventful surgical procedure without postpartum hemorrhage. The replacement therapy of fibrinogen or fresh frozen plasma administration was essential to avoid anesthesia and obstetric complications. Regional blockade could safely be offered in the caesarean section, providing that their coagulation defect was corrected by availability of therapeutic products and adequate response to treatment. In addition, the point-of-care rotational thrombelastometry (ROTEM) or thrombelastogram (TEG) could play an important role in an optimal perioperative management for such patients. Management plans must be tailored to each individual, taking into consideration their bleeding risk as well as potential maternal and neonatal complications.

Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA).</p><p><b>METHODS</b>We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups.</p><p><b>RESULTS</b>During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups.</p><p><b>CONCLUSIONS</b>Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.</p>

Application and research progress of bone marrow mesenchymal stem cells in corneal injury repair / 国际眼科杂志(Guoji Yanke Zazhi)

Bone marrow mesenchymal stem cells (BMSCs) are a class of cells that can differentiate into different kind of corneal cells both in vitro and in vivo,which include corneal epithelial cells,limbal epithelial cells and corneal stromal cells.BMSCs could differentiate into corneal epithelial cells after transplantation,which can not only repair the damaged corneal,but also relieve inflammatory injury caused by the inflammatory cell infiltration.The other function of BMSC transplantation is to reduce the rejection after corneal transplantation by inhibiting cell damage and apoptosis.BMSC can also express a variety of factors on the carrier,these factors paly the important role in promoting the proliferation of limbal stem cells.These findings above provide a new direction for the fundamental study of ophthalmology,and put forward new clinical treatment ideas for corneal disease,both of them have broad protect for development,in this paper,the research status and progress of BMSC in the repair of corneal injury are reviewed.