Establishment and validation of a nomogram to predict progression free survival of patients with thymoma / 中华胸心血管外科杂志

Objective:To explore the prognostic risk factors of thymoma patients after resection, and establish a novel nomogram to predict progression free survival(PFS) of patients with thymoma.Methods:A retrospectively analysis was performed on clinicopathological datas of 267 cases of thymoma patients underwent thymoma resection in Beijing Tongren Hospital from January 2010 to December 2019. The univariate and multivariate Cox risk ratio models were used to analyze the related factors that might affect PFS, and the prediction nomogram of PFS after thymoma resection was established using the screened independent risk factors. Then the predictive ability of the model was evaluated. Results:The univariate analysis showed that age, type of surgery, completeness of resection, WHO histologic classification, TNM stage and postoperative adjuvant therapy were significantly correlated with PFS after thymoma resection( P<0.05). The multivariate analysis showed that only age and TNM stage were independent prognostic factors affecting PFS after thymoma resection( P<0.05). The concordance index( C- index) of the prediction model for the prognosis of thymoma patients established by this method was 0.866(95% CI: 0.809-0.923), which had remarkable predictive efficiency. Conclusion:The nomogram model is constructed and verified based on age and TNM stage, excluding the interference of other clinicopathological factors on prognosis assessment, and which is convenient for clinicians to quickly and individually evaluate the prognosis of patients after thymoma resection.

Comprehensive Analysis of the Relationship between m6A Methylation Patterns and Immune Microenvironment in Lung Adenocarcinoma / 中国肺癌杂志

BACKGROUND@#m6A RNA methylation modification plays an important role in the occurrence and progression of lung cancer and regulates tumor immunity. Current studies mostly focus on the differential expression of some specific m6A effectors and infiltrating immune cell. m6A methylation modification is the result of mutual adjustment and balance between effectors, and changes in the expression of one or two effectors are far from enough to reflect the panorama of m6A methylation. The role of m6A in the immune microenvironment of lung adenocarcinoma (LUAD) is still poorly understood. The aim of this study is to investigate the effect of different m6A modification patterns in immune microenvironment of LUAD.@*METHODS@#LUAD data was obtained from The Cancer Genome Atlas (TCGA), University of California Santa Cruz Xena (UCSC Xena) and Gene Expression Omnibus (GEO) databases. Gene mutation, differential expression and survival analysis were performed for 24 m6A effectors. The m6A modification pattern was constructed by unsupervised clustering method, and the m6A clusters survival analysis, gene set variation analysis, immune score and immune cell infiltration analysis were performed. The association between LRPPRC protein expression levels and infiltration of CD8+ cytotoxic T lymphocytes and CD68+ macrophages in the tumor microenvironment was validated by immunohistochemistry in LUAD tissue microarray with 68 cases.@*RESULTS@#The mutations of m6A effector were found in 150 of 567 LUAD cases with a frequency of 26.46%. 6 readers and 3 writers were significantly up regulated in LUAD tissues compared with normal tissues. IGF2BP1 and HNRNPC are the independent risk factors for prognosis of LUAD. Abundant cross-talks among writers, erasers and readers were demonstrated. Three m6A modification patterns with different immune cell infiltration characteristics and clinical prognosis were established. Among m6A effectors, LRPPRC was found to be inversely associated with the infiltration of CD8+ cytotoxic T lymphocytes and CD68+ macrophages, and was validated in 68 LUAD tissues.@*CONCLUSIONS@#m6A modification patterns play non-negligible roles in regulating the immune microenvironment. LRPPRC has potential to be a new biomarker for checkpoint inhibitor immunotherapy.

A descriptive analysis on coronary heart disease in adult twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of coronary heart disease in adult twins recruited from Chinese Twin Registry (CNTR), and provide clues and evidence for the effect of genetic and environmental influences on coronary heart disease. Methods: By using the data of CNTR during 2010-2018, a total of 34 583 twin pairs aged ≥18 years who completed questionnaire survey and had related information were included in the current study to analyze the population and area distribution characteristics of coronary heart disease. Random effect models were used to compare the differences between groups. The concordane rate of coronary heart disease were calculated respectively in monozygotic (MZ) twin pairs and dizygotic (DZ) twin pairs to estimate the heritability. Results: The twin pairs included in this analysis were aged (34.2±12.4) years. The overall prevalence rate of coronary heart disease in twin pairs was 0.7%. Twin pairs who were women, older, obese and lived in northern China had higher prevalence of coronary heart disease (P<0.05). Intra-pair analysis in the same-sex twin pairs found that the concordane rate of coronary heart disease was higher in MZ twin pairs (25.3%) than in DZ twins (7.4%), and the difference was statistically significant (P<0.001). The overall heritability of coronary heart disease was 19.3% (95%CI: 11.8%-26.8%). Stratified by gender, age and area, the concordane rate was still higher in MZ twin pairs than in DZ pairs. Participants who were women, aged 18-30 years or ≥60 years and lived in northern China had a higher heritability of coronary heart disease. Conclusion: The distribution of coronary heart disease in twin pairs differed in populations and areas. The prevalence of coronary heart disease was affected by genetic factors, but the effect varied with age, gender and area.

Application of esophageal varus extraction in the treatment of laryngopharyngeal and cervical esophageal tumors / 中华胸心血管外科杂志

Objective:To investigate the application and effect of esophageal varus extraction in the treatment of cervical tumors(laryngopharynx and cervical esophagus).Methods:A retrospective analysis was performed on 238 patients with cervical tumors(laryngopharynx and cervical esophagus) who underwent thoracic surgery in Beijing Tongren Hospital affiliated to Capital Medical University from March 2010 to March 2020. There were 135 males and 103 females, aged from 42 to 78 years, with a median age of 62 years.Surgical methods included open abdominal surgery in 96 cases and laparoscopic surgery in 142 cases. The intraoperative abdominal bleeding volume, abdominal operation time and postoperative abdominal drainage volume were analyzed. χ2 test was used to compare the clinical characteristics of the two groups, t test was used to compare the clinical indicators, and statistical software SPSS 13.0 was used to analyze. Results:No intraoperative death occurred in all patients.In the laparoscopic group, all cases successfully completed tubular gastric traction through the original esophageal bed to the neck, and completed cervical anastomosis.One patient(0.70%) was converted to thoracotomy due to aortic tear, and no post-operative bleeding occurred.No incision infection and wound liquefaction. Splenectomy was performed in 1 patient(1.04%), incision infection in 2 patients(2.08%), and fat liquefaction in 3 patients(3.12%) in the open surgery group.The intraoperative abdominal bleeding volume in the open surgery group and the laparoscopic group was(187±28)ml and(79±23)ml, respectively( t=1.836, P=0.032); the postoperative abdominal drainage volume in the two groups was(172±33)ml and(56±24)ml, respectively( t=1.964, P=0.028), and there was a significant difference between the two groups.The operation time of open operation group and laparoscopy group was(125±33) min and(118±27) min respectively( t=1.224, P=0.203), and there was no significant difference between the two groups. Conclusion:Laparoscopic esophageal varus extraction has advantages over traditional laparotomy in the treatment of laryngopharyngeal tumors and cervical esophageal tumors, such as beautiful incision, small surgical trauma, clear surgical field exposure and less postoperative complications, which conforms to the current minimally invasive treatment concept.The application of pneumoperitoneum-free suspension device solves the key links of mediastinal compression hemostasis after esophageal extubation and traction of tubular stomach to neck under pneumoperitoneum-free condition, so that laparoscopic surgery can be applied.However, such operations need to strictly grasp the indications to avoid the occurrence of serious complications.

Imaging and clinical features of sub-centimeter solitary pulmonary nodules with ground glass opacity on CT / 中华全科医师杂志

Objective:To analyze the clinical and CT imaging characteristics of sub-centimeter solitary pulmonary nodules (SSPNs) with ground glass opacity.Methods:The clinical and imaging data of 258 patients with SSPN who underwent surgical treatment in Beijing Tongren Hospital from May 2015 to May 2020 were retrospectively reviewed. There were 113 males and 145 females with a median age of 45 (range 30-84) years. The CT images of the lesions showed ground glass opacity, including 60 cases of pure ground glass nodule (pGGO) and 198 cases of mixed ground glass nodule (mGGO). The largest diameter of the lesion was ≤ 10 mm, and the lesions were all resected by video-assisted thoracic surgery, and diagnosed by postoperative pathological examination. The relationship between the lesion size and the detection rate of malignancy; the diagnostic value of CT imaging features for differentiating benign and malignant SSPN, and postoperative immunohistochemical indexes and target gene mutations for differentiating primary from metastatic lung cancer were analyzed.Results:Of the 258 patients, 59 had lesions<7 mm in diameter and 199 between 7 and 10 mm in size. There were no intraoperative deaths. The postoperative pathological examination confirmed primary bronchial lung cancer in 190 cases, metastatic lung cancer in 12 cases, and benign lung lesions in 56 cases. The detection rates of malignant lesions in mGGO and pGGO were 81.31% (161/198) and 68.33% (41/60), respectively (χ 2=4.66, P = 0.032). The detection rates of malignant lesions and primary cancer in mGGOS with diameter 7-10 mm was higher than those with diameter<7 mm[(87.01%(134/154) vs. 61.37%(27/44) and 83.77%(129/154) vs. 56.82%(24/44), χ 2=14.82, χ 2=12.93, all P<0.001 ]. The border irregularity on CT imaging was presented in 47.03% (95/202) of malignant lesions, which presented in 48.42% (92/190) of primary lung cancers; while only presented in 17.86% (10/56) of benign lung lesions (χ 2=15.46, χ 2=16.64, all P<0.001). The frequency of vascular signs was 56.44% (114/202) in lung malignant lesions, 54.74% (110/190) in primary bronchial lung cancer; while only 5.35% (3/56) in lung benign lesions (χ 2=46.16, χ 2=48.07, all P<0.001). Among mGGO patients with lesion diameter<7 mm, those with irregular lesion borders and vascular signs on CT imaging 91.30% (21/23) were pulmonary malignant lesions, while those without these two signs only 28.57% (6/21). Immunohistochemistry results showed that the primary bronchial lung cancer group had a higher positive rate of new aspartic proteinase A (Napsin A, 79.47%) and thyroid transcription factor-1 (TTF-1, 75.79%) than the metastatic lung cancer group. There were three patients with BRAF-v600e mutation in our series, and all of them were finally confirmed as metastatic thyroid cancer. Conclusion:In sub-centimeter solitary pulmonary nodules with ground glass opacity, mGGO lesions are more likely to be malignant lesions than pGGO lesions, and the lesions with larger size are more likely to be malignant. Imaging features such as irregular lesion borders and vascular signs are important in differentiating between benign and malignant lesions. For metastatic lesions, immunohistochemical and genetic testing are helpful in determining the primary tumor site.

Clinical Efficacy and Mechanism of Modified Yihuo Qinggan Tuiyi Tang in Treating Herpes Simplex Keratitis with Liver Meridian and Wind-heat / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of modified Yihuo Qnggan Tuiyi Tang on herpes simplex keratitis with liver meridian and wind-heat，so as to explore its mechanism of action. Method:Totally 130 patients with herpes simplex keratitis with liver meridian and wind-heat were randomly divided into control group and observation group，with 65 cases in each group. The control group was treated with conventional western medicine，while the observation group was treated with modified Yihuo Qinggan Tuiyi Tang in addition to the therapy of the control group for 4 weeks. The clinical efficacy，traditional Chinese medicine（TCM） syndrome score，symptoms and signs，adverse reactions and recurrence rate of the two groups were compared. The levels of serum interferon gamma（IFN-γ），interleukin-6（IL-6），interleukin-8（IL-8） inflammatory factors，malondialdehyde (MDA)，antioxidant activity (TAC)，glutathione peroxidase（GSH-PX）of oxidative stress indexes were detected by enzyme linked immunosorbent assay （ELISA）. The levels of CD4+ and CD8+ were measured by flow cytometry. The recurrence rate was observed during 1-year follow-up visit. Result:The total effective rate of observation group was better than that of control group (Z=2.161，P<0.05). After treatment，the scores of eye pain，shame，photophobia，tears，vision loss，redness and total eyelid swelling were significantly lower than those of control group (P<0.05). The total effective rate of TCM syndrome in the observation group was better than that of control group (Z=2.540，P<0.05). After treatment，the scores of pain，eyelid redness，conjunctival congestion，corneal punctate pannus，corneal pannus and corneal pannus depth of symptoms and signs in observation group were better than those of control group (P<0.05). The level of serum IFN-γ in observation group was higher than that of control group，and the levels of IL-6 and IL-8 were lower than those of control group (P<0.05). Levels of MDA in the observation group was higher than that of control group (P<0.05). The levels of CD4+and CD4+/CD8+ in observation group were higher than those of control group，and the levels of CD8+ were lower than that of control group (P<0.05). The recurrence rate in observation group was significantly lower than that in control group after withdrawal for 6 months and 12 months (P<0.05). Conclusion:In addition to the therapy of routine western medicine， modified Yihuo Qinggan Tuiyi Tang has a good clinical efficacy in treating herpes simplex keratitis with liver meridian and wind-heat，and can reduce the scores of TCM syndromes，alleviate symptoms and signs，and reduce the recurrence rate. Its mechanism may be related to reducing inflammation reaction，and improving oxidative stress index and immune function.

Effect of Addition and Subtraction Therapy of Chuanxiong Chatiaosan Combined with Acupuncture on Acute Migraine Attack with Syndrome of Wind Phlegm Blocking Collaterals and Neurovascular Active Medium / 中国实验方剂学杂志

Objective:To observe the efficacy of addition and subtraction therapy of Chuanxiong Chatiaosan combined with acupuncture for acute migraine attack with syndrome of wind phlegm blocking collaterals and to investigate its effect on neurovascular active medium. Method:One hundred and thirty-four patients were randomly divided into control group（67 cases） and observation group （67 cases）by random number table. During the treatment， 63 patients completed the study in control group （loss to follow-up in 2 cases， and elimination in 2 cases）. 64 patients completed the study in observation group （loss to follow-up in 3 cases）. Patients in both groups got ibuprofen sustained release tablets， 1 tablet/time， 2 times/day， Zolmitriptan tablets， 2.5 mg/time， 1 time/day， which were stopped when symptoms got relieved. Patients in control group got acupuncture treatment， 1 time/day， and Zhengtian pills by oral administration， 6 g/time， 2 times/day. Based on the treatment of acupuncture in control group， patients in observation group additionally received addition and subtraction therapy of Chuanxiong Chatiaosan， 1 dose/day， with a treatment course of 10 days in both groups. Before treatment， at the first day （2， 4 ， 12 ， 24 h） and second to tenth day after the treatment， scores of pain visual analoguescale （VAS） were graded； before and after treatment， scores of duration and degree of headache， concomitant symptoms， number of headache attacks， syndrome of wind phlegm blocking collaterals， migraine specific quality of life scale （MSQ） were graded. Levels of nitric oxide （NO）， endothelin-1 （ET-1）， calcitonin gene-related peptide （CGRP）， 5-hydroxytryptamine （5-HT）， and β endorphin （β -EP） were detected before and after treatment. Result:The clinical efficacy in observation group was better than that in control group （Z=2.115， P<0.05）. At the second and fourth hour after treatment， VAS scores were decreased in both groups， but there was no statistically significant difference between two groups. At the 12th and 24th hour after treatment， VAS scores were increased as compared with those at the previous time point （P<0.01）， and VAS scores in observation group at the 12th and 24th hour were lower than those in control group （P<0.01）， but there was no statistically significant difference in onset time for pain， effective rate for pain at second hour after treatment and the disappearance rate of pain at the third day after treatment. Time to pain relief in observation group was shorter than that in control group （P<0.01）. Degree of headache， duration of headache， number of headache attacks and accompanying symptoms were all lower than those in control group， while scores of MSQ and the total score of MSQ were all higher than those in control group （P<0.01）. Recurrence rate of pain in observation group was 18.75% （12/64）， lower than 36.51% （23/63） in control group at the 24th hour （P<0.05）. Disappearance rate of pain in observation group was 70.31% （45/64） and 90.63% （58/64） at the fifth day and tenth day after treatment， higher than 52.38% （33/63） and 76.19% （48/63） in control group （P<0.05）. Levels of NO， β-EP and 5-HT were higher than those in control group （P<0.01）， while levels of CGRP and ET-1 were lower than those in control group （P<0.01）. Conclusion:Chuanxiong Chatiaosan combined with acupuncture in the treatment of acute migraine attack in patients， has equivalent effect in terms of rapid pain relief， but with advantages of long-lasting analgesic effect， low recurrence rate， high pain relief rate and disappearance rate. In addition， it can also regulate neurovascular active mediators， more effectively control acute migraine attack， and improve the quality of life of patients， with a better clinical efficacy.

Advances on the Asymptomatic Infection of COVID-19 / 中华流行病学杂志

The COVID-19 outbreak in China has been gradually controlled. At present, the management and risk assessment of asymptomatic infected cases has become an urgent problem to be addressed. Asymptomatic case is mainly detected by close contact screening, cluster epidemic investigation, infection source tracking investigation, and active detection of target population. Currently, research on the spread risk from asymptomatic cases was limited, and lacking the data relates to the distribution of asymptomatic cases in large community population. Pathogen detection using PCR is suitable for screening in close contacts of confirmed cases and should be started as early as possible. The antibody test is more suitable for screening in general population where the source of infection is unclear. The management of asymptomatic cases now in China focuses on isolation and medical observation according to the guideline of 'early detection, early report, early isolation and early treatment' .

Rare variants of Bosworth fracture-dislocation: Bosworth fracture-dislocation with medial malleolus adduction type fracture / 中华创伤杂志(英文版)

Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracture-dislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotation adduction. These types have not been described before. In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.

Undisplaced subtle ligamentous Lisfranc injuries, conservative or surgical treatment with percutaneous position screws? / 中华创伤杂志(英文版)

PURPOSE@#Undisplaced subtle ligamentous Lisfranc injuries are easy to miss or underestimate, and many cases are treated without surgical fixation. It has not yet widely known whether conservative treatment for undisplaced subtle ligamentous Lisfranc injuries may lead to a poor outcome. The purpose of this study is to compare the outcomes of conservative versus surgical management (percutaneous position screw) of undisplaced subtle ligamentous Lisfranc injury.@*METHODS@#We analysed 61 cases in this retrospective study, including 38 males and 23 females. Forty-one patients were managed conservatively, while 20 patients received surgical treatment involving minimal invasive percutaneous position screw. American orthopaedic foot &ankle society (AOFAS), foot function index (FFI, including FFI disability, FFI pain score and activity limitation scale) scores, Maryland foot score and short form-36 (SF-36) were recorded and compared after a follow-up of 10-16 months (average 12.3).@*RESULTS@#Patients in the surgical management group had higher scores in all evaluation methods (p < 0.05). The complications in the conservative management group had higher incidence, mainly including secondary diastasis (34.1% vs. 5.0%), joint stiffness after 3 months (82.9% vs. 0%), and secondary arthrodesis (12.2% vs. 0%). The highest rate of complication in surgical management group was temporary forefoot pain (55.0%).@*CONCLUSION@#The results of this study suggest that the outcomes of the surgical management with percutaneous position screw fixation are better than the conservative management to treat undisplaced subtle ligamentous Lisfranc injuries. This study can serve as a resource for orthopaedic surgeons in recognizing and managing such injuries.

Effects of puerarin on H2O2-induced SH-SY5Y cell apoptosis / 中国药理学通报

Aim To investigate the neuroprotective effects of puerarin on H2O2-induced SH-SY5Y cell ap-optosis and the molecular mechanisms underlying the neuroprotective effects. Methods Neuron injury mod-el was established in vitro through H2O2-induced SH-SY5Y injury. MTT assay was performed to detect the effect of puerarin on H2O2-induced SH-SY5Y survival rates. Hoechst 33342 staining was used to observe the cell apoptosis. JC-1 staining was employed to detect the level of mitochondria membrane poential. Caspase-3 was determined by caspase-3 catalyze the substrate specificity Ac-DEVD-pNA. Caspase-9 was determined by caspase-9 catalyze the substrate specificity Ac-LE-HD-pNA. The effects of puerarin on the protein level of Bcl-2,Bax,p-Akt and Akt were determined by West-ern blot. Results The cell survival rate significantly increased after puerarin pretreatment compared with H2O2model group. Furthermore, puerarin pretreat-ment not only inhibited the decreasing of mitochondrial membrane potential,increasing of caspase-3, caspase-9 enzymatic activity and the expression of Bax,but also promoted the expression of p-Akt and Bcl-2, which was prevented by LY294002, an inhibitor of PI3K/Akt. Conclusion Puerarin can play a neuroprotective role for SH-SY5Y cell apoptosis induced by H2O2, maybe via activating PI3K/Akt signaling pathway.

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy / 中华医学杂志(英文版)

<p><b>Background</b>The co-existence of myasthenia gravis (MG) and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.</p><p><b>Methods</b>A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery (Group A); whereas the other 24 patients did not receive radiation therapy (Group B). According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups (1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52). We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission (CSR) rate as the primary endpoints.</p><p><b>Results</b>There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B (χ = 4.631, P = 0.031). The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.</p><p><b>Conclusions</b>Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.</p>

Therapeutic effect of oridonin on mice with prostate cancer

OBJECTIVE@#To investigate the therapeutic effect and the related mechanism of oridonin on mice with prostate cancer.@*METHODS@#Sixty BALB/C male nude mice were selected. A model of RM-1 cell transplantation tumor of prostate cancer was built by the subcutaneous inoculation of RM-1 cells. After that, those 60 experimental mice were randomly divided into groups A, B and C. Each group had 20 mice. Mice in group A were treated with 0.2 mL of normal saline (0.9%) by intraperitoneal injection once a day; mice in group B received intraperitoneal injection of 1.875 mg/mL of oridonin once a day; and mice in group C received intraperitoneal injection of 7.5 mg/mL of oridonin once a day. Mice in the three groups were treated uninterruptedly for 5 weeks and were all killed. Then, tumors were excised and weighed to calculate their growth inhibitory rate, volume increment and anti-tumor rate. Thymus and spleen of mice in the three groups were collected to calculate the thymus and spleen index. Immunohistochemical staining was applied to observe the expression of caspase-3 in prostate cancer tissue of mice of the three groups.@*RESULTS@#The qualities and volume increment of tumors in groups B and C were significantly lower than those of group A (P  0.05). Immumohistochemical staining revealed that the caspase-3 protein in prostate cancer tissue of mice of group A expressed negatively with colorless or light-colored karyon; while the caspase-3 protein in prostate cancer tissue of mice of group B expressed positively with dark-colored karyon, centralized distribution and granular sensation; and the caspase-3 in prostate cancer tissue of mice of group C showed strong positive expression with big and darker colored karyon and dense distribution.@*CONCLUSIONS@#Oridonin can inhibit the growth of RM-1 prostate cancer cells effectively and have great therapeutic effects on RM-1 cell transplantation tumor of prostate cancer.

Research Progress on Relationship Between Gastroesophageal Flap Valve and Gastroesophageal Reflux Disease / 中国微创外科杂志

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Therapeutic effect of oridonin on mice with prostate cancer

Objective: To investigate the therapeutic effect and the related mechanism of oridonin on mice with prostate cancer. Methods: Sixty BALB/C male nude mice were selected. A model of RM-1 cell transplantation tumor of prostate cancer was built by the subcutaneous inoculation of RM-1 cells. After that, those 60 experimental mice were randomly divided into groups A, B and C. Each group had 20 mice. Mice in group A were treated with 0.2 mL of normal saline (0.9%) by intraperitoneal injection once a day; mice in group B received intraperitoneal injection of 1.875 mg/mL of oridonin once a day; and mice in group C received intraperitoneal injection of 7.5 mg/mL of oridonin once a day. Mice in the three groups were treated uninterruptedly for 5 weeks and were all killed. Then, tumors were excised and weighed to calculate their growth inhibitory rate, volume increment and anti-tumor rate. Thymus and spleen of mice in the three groups were collected to calculate the thymus and spleen index. Immunohistochemical staining was applied to observe the expression of caspase-3 in prostate cancer tissue of mice of the three groups. Results: The qualities and volume increment of tumors in groups B and C were significantly lower than those of group A (P 0.05). Immumohistochemical staining revealed that the caspase-3 protein in prostate cancer tissue of mice of group A expressed negatively with colorless or light-colored karyon; while the caspase-3 protein in prostate cancer tissue of mice of group B expressed positively with dark-colored karyon, centralized distribution and granular sensation; and the caspase-3 in prostate cancer tissue of mice of group C showed strong positive expression with big and darker colored karyon and dense distribution. Conclusions: Oridonin can inhibit the growth of RM-1 prostate cancer cells effectively and have great therapeutic effects on RM-1 cell transplantation tumor of prostate cancer.

The relationship between myasthenia gravis and the different pathological type of thymoma patients' operation and prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the different pathological and clinical characteristics of thymomas with and without myasthenia gravis (MG) and to determine whether the presence of MG influences the prognosis in thymoma patients.</p><p><b>METHODS</b>The clinical data from 228 consecutive patients (median sternotomy were used in 153, video-assisted thoracoscopic themectomy were used in 75) operated on from January 1992 to December 2007 was analyzed retrospectively. These thymoma patients had been subdivided into two groups: thymoma with MG (n = 125) and thymoma without MG (n = 103). All thymic epithelial tumors were classified according to the WHO histologic classification and the Masaoka clinical staging system. The result was evaluated according to the Myasthenia Gravis Foundation of America's criterion. The clinical features of the 2 test was compared between the two groups by χ² test, and the survival were compared between the two groups by Cox analysis.</p><p><b>RESULTS</b>There were no peri-operative deaths. 19 cases were inoperable (6 in the group with MG, 13 without MG (χ² = 4.52, P = 0.035)). The proportions of type A and thymic carcinoma were 0 in the group with MG, 10.5% (11/103) and 11.6% (12/103) respectively in the group without MG. According to the Masaoka's clinical staging, in the group MG, 24.8% (31/125) patients were stage III and IV; in the group without MG, 33.0% (34/103) patients were stage III and IV. There was a significant difference between hyperplastic paraneoplastic thymus coexisting in 28.8% (36/125) patients with MG and only 5.8% (6/103) in patients without MG (χ² = 20.91, P = 0.000) Microthymoma was identified in the paraneoplastic thymus of 3 patients with MG. There were 198 patients followed up, the rate was 86.8% (198/228). There was no recurrence in patients with type A and a few patients with type AB, B1, B2, B3 thymoma and thymic carcinoma recurred. The actuarial 5- and 10-year survival rates were 89.3% and 81.2% for patients with MG respectively, and 90.0% and 78.9% for patients without MG respectively. Within 5 years postoperatively, 6 of 9 patients with MG died of myasthenia crisis, while 6 out of 7 deaths in patients without MG were attributable to inoperable tumors (stage IV) and thymic carcinoma.</p><p><b>CONCLUSIONS</b>The existence of myasthenia gravis has little influence on the prognosis of thymomas, but it is good for early diagnosis and treatment. Extended thymectomy should be performed to all patients with thymoma, no matter they have myasthenia gravis or not. The main cause of death is myasthenia crisis for thymoma patients with MG and stage IV and (or) thymic carcinoma for patients without MG.</p>

Effectiveness of niacinamide used on hyperphosphatemia patients undergoing hemodialysis / 中华肾脏病杂志

Objective To study the effectiveness of niacinamide in treating maintenance hemodialysis patients with hyperphosphatemia.Methods It was a prospective and randomized controlled trial.Patients with hyperphosphatemia (serum phosphate ＞ 1.45 mmol/L) were randomly assigned into two groups:control group (continue their original phosphate binder and rocaltrol treatment) and niacinamide therapy group (additionally received niacinamide,titrated from 600 mg/d to 1200 mg/d).The treatment lasted for 8 weeks.Serum phosphate and calcium were tested every 2 weeks and normalized protein catabolic rate and other relevant indexes were tested monthly.Results 100 patients were recruited and 93 of them completed the trial,including 44 from the therapy group and 49 from the control group.By the repeated measures analysis of variance,changes of serum phosphate in two groups displayed a statistical significant difference,but the levels of serum calcium in both remained steady.At the end of trial,compared to control group,therapy group appeared decreased serum phosphate levels [(1.59±0.36) mmol/L vs (1.94±0.25) mmol/L,P ＜ 0.001] and increased serum HDL levels [(1.32±0.54) mmol/L vs (1.09±0.41) mmol/L,P=0.02].Meanwhile,two groups showed no significant difference in intact parathyoid hormone and alkaline phosphatase.Adverse reactions including thrombocytopenia and gastrointestinal dysfunction were observed in niacinamide therapy group.Conclusions Niacinamide is effective on controlling hyperphosphatemia along with phosphate binder in maintenance hemodialysis patients.It also increases the serum HDL levels.Nonetheless,it is important to monitor the number of platelet.

Factors influencing outcomes after cardiopulmonary resuscitation in emergency department / 世界急诊医学杂志（英文）

BACKGROUND:The outcome of cardiopulmonary resuscitation (CPR) may depend on a variety of factors related to patient status or resuscitation management. To evaluate the factors influencing the outcome of CPR after cardiac arrest (CA) will be conducive to improve the effectiveness of resuscitation. Therefore, a study was designed to assess these factors in the emergency department (ED) of a city hospital.METHODS:A CPR registry conforming to the Utstein-style template was conducted in the ED of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2011. The outcomes of CPR were compared in various factors groups. The primary outcomes were rated to return of spontaneous circulation (ROSC), 24-hour survival, survival to discharge and discharge with favorable neurological outcomes. Univariate analysis and multivariable logistic regression analysis were performed to evaluate factors associated with survival.RESULTS:A total of 725 patients were analyzed in the study. Of these patients, 187 (25.8％) had ROSC, 100 (13.8％) survived for 24 hours, 48 (6.6％) survived to discharge, and 23 (3.2％) survived to discharge with favorable neurologic outcomes. A logistic regression analysis demonstrated that the independent predictors of ROSC included traumatic etiology, first monitored rhythms, CPR duration, and total adrenaline dose. The independent predictors of 24-hour survival included traumatic etiology, cardiac etiology, first monitored rhythm and CPR duration. Previous status, cardiac etiology, first monitored rhythms and CPR duration were included in independent predictors of survival to discharge and neurologically favorable survival to discharge.CONCLUSIONS:Shockable rhythms, CPR duration ≤15 minutes and total adrenaline dose ≤5 mg were favorable predictors of ROSC, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms and CPR duration ≤15 minutes were favorable predictors of 24-hour survival, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms, CPR duration ≤15 minutes were favorable predictors of survival to discharge and neurologically favorable survival to discharge, but previous terminal illness or multiple organ failure (MOF) was unfavorable.

Gene polymorphism loci influencing valproic acid interindividual differences by bioinformatic methods / 中国药学杂志

OBJECTIVE: To look for gene polymorphism loci influencing valproic acid interindividual differences, thus to provide support for treating epilepsy patients with valproic acid. METHODS: Through the KEGG Database, genes and their loci influencing valproic acid pharmacokinetics and pharmacodynamics were inquired from the perspective of pathway: literature was searched about valproic acid-related gene polymorphisms: the FastSNP was used to estimate the risk of the genes found from KEGG Database and literature: the dbSNP database was used to find the distribution of the gene loci with higher risk in Chinese and then to select the loci for the experimental study. RESULTS: The related gene inquired from the perspective of pathway were ABAT, CACNA1I, CACNA1H, CACNA1G, CDY2B, CDY1B, CDY1, CDY2A, CYP2C9, and CYP3A4. Through literature search and bioinformatics methods, 29 influencing loci on valproic acid were identified, including rs1641021, rs1731017, and rs1057910, and so on. CONCLUSION: From this bioinformatics research, the gene polymorphism loci affecting valproic acid interindividual difference are successfully screened. This study provides genetics basis for individual treatments of epileptic patients.

Surgical effect of dysphagia in patients with bulbar myasthenia gravis / 中华全科医师杂志

To retrospectively analyze the clinical data of 42 patients at our department with bulbar myasthenia gravis.They underwent video-assisted thoracoscopic extended thymectomy (VATET) from May 2003 to August 2010.Another 42 patients treated with medications alone were selected as controls.Compared with the control group (4.32 ± 0.23),postoperative dysphagia scores improved significantly in patients undergoing VATET(9.21 ±0.41).And so did the dysphagia assessment classification (P ＜0.05).Thus VATET could effectively and definitely relieve dysphagia in patients with bulbar myasthenia gravis.