Characteristics of new corneal biomechanical parameters in different degrees of myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the characteristics of new corneal biomechanical parameters in different degrees of myopia and analyze the correlation of the new parameter stress-strain index(SSI).METHODS: A cross-sectional study was conducted on 366 adult patients(718 eyes)with different degrees of myopia who received treatment at the First Affiliated Hospital of Dali University from October 2021 to November 2021, aged 18-50 years, and the spherical equivalent(SE)was -0.50～-16.75D. The axial length(AL)of the eye was measured by IOL master, and the new corneal biomechanical parameters, central corneal thickness(CCT)and intraocular pressure(IOP)were measured by corneal visualization Scheimpflug technology(Corvis ST). The subjects were categorized into low myopia, moderate myopia and high myopia groups according to SE. The data were analyzed by ANOVA and Pearson correlation.RESULTS: The ratio of the thinnest corneal thickness to horizontal thickness change rate(ARTh)and SSI were statistically significant(P<0.001), while the remaining parameters were not statistically significant(P>0.05). SSI was positively correlated with age(r=0.102, P=0.006), SE(r=0.361, P<0.001), IOP(r=0.175, P<0.001), CCT(r=0.098, P=0.009), SPA1(r=0.182, P<0.001), negatively correlated with AL(r=-0.331, P<0.001), IR(r=-0.545, P<0.001)and had no correlation with other corneal biomechanical parameters(P>0.05).CONCLUSION: With the increase of myopia degree and the elongation of the axial length, the SSI value becomes smaller and the corneal hardness decreases. SSI may be a helpful corneal biomechanical indicator for future research on myopia.

HBXIP blocks myosin-IIA assembly by phosphorylating and interacting with NMHC-IIA in breast cancer metastasis

Tumor metastasis depends on the dynamic balance of the actomyosin cytoskeleton. As a key component of actomyosin filaments, non-muscle myosin-IIA disassembly contributes to tumor cell spreading and migration. However, its regulatory mechanism in tumor migration and invasion is poorly understood. Here, we found that oncoprotein hepatitis B X-interacting protein (HBXIP) blocked the myosin-IIA assemble state promoting breast cancer cell migration. Mechanistically, mass spectrometry analysis, co-immunoprecipitation assay and GST-pull down assay proved that HBXIP directly interacted with the assembly-competent domain (ACD) of non-muscle heavy chain myosin-IIA (NMHC-IIA). The interaction was enhanced by NMHC-IIA S1916 phosphorylation via HBXIP-recruited protein kinase PKCβII. Moreover, HBXIP induced the transcription of PRKCB, encoding PKCβII, by coactivating Sp1, and triggered PKCβII kinase activity. Interestingly, RNA sequencing and mouse metastasis model indicated that the anti-hyperlipidemic drug bezafibrate (BZF) suppressed breast cancer metastasis via inhibiting PKCβII-mediated NMHC-IIA phosphorylation in vitro and in vivo. We reveal a novel mechanism by which HBXIP promotes myosin-IIA disassembly via interacting and phosphorylating NMHC-IIA, and BZF can serve as an effective anti-metastatic drug in breast cancer.

Clinical efficacy of laparoscopic-assisted intersphincteric resection with different surgical approaches for low rectal cancer / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic-assisted inters-phincteric resection (ISR) with different surgical approaches for low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 90 patients with low rectal cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2020 were collected. There were 58 males and 32 females, aged (60±9)years. Of 90 patients, 60 cases underwent laparoscopic assisted ISR with transpelvic approach, 30 cases underwent laparoscopic assisted ISR with transabdominal and transanal mixed approach. Observation indicators: (1) clinicopathological characteristics of patients with transpelvic approach and mixed approach; (2) intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach; (3) postoperative complications of patients with transpelvic approach and mixed approach; (4) follow-up. Follow-up was conducted by telephone interview and outpatient examination once every 3 months within postoperative 3 years, once every six months in the postoperative 3 to 5 years and once a year after postoperative 5 years to detect tumor recurrence and metastasis, and survival of patients.Follow-up was up to March 2021 or patient death. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the non-parametric Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by the non-parametric rank sum test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and survival analysis was performed by the Log-Rank test. Results:(1) Clinicopathological characteristics of patients with transpelvic approach and mixed approach. The sex (males, females), distance from the distal margin of tumor to anal margin were 34, 26, (4.5±0.5)cm for patients with transpelvic approach, versus 24, 6, (3.5±0.5)cm for patients with mixed approach, respectively, showing significant differences between them ( χ2=4.75, t=8.35, P<0.05). (2) Intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach. The operation time, volume of intraoperative blood loss, distance from the postoperative anastomosis to anal margin were (187±9)minutes, 50(range, 20?200)mL, (3.4±0.7)cm for patients with transpelvic approach, versus (256±12)minuets, 100(range, 20?200)mL, (2.6±0.7)cm for patients with mixed approach, showing significant differences between them ( t=?26.99, Z=?2.48, t=4.67, P<0.05). None of the 90 patients had a positive distal margin. The stoma reversal rates of patients with transpelvic and mixed approach were 93.3%(56/60) and 90.0%(27/30), respectively. Of the 60 patients with transpelvic approach, 3 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. Of the 30 patients with mixed approach, 2 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. The 1-, 3-month Wexner scores after stoma reversal were 15(range, 12?17), 12(range, 10?14) for patients with transpelvic approach, versus 16(range, 14?18), 14(range, 12?16) for patients with mixed approach, showing significant differences between them ( Z=?4.97, ?5.49, P<0.05). The 6-month Wexner score after stoma reversal was 10(range, 9?12) for patients with transpelvic approach, versus 11(range, 8?12) for patients with mixed approach, showing no significant difference between them ( Z=?1.59, P>0.05). (3) Postoperative complications of patients with transpelvic approach and mixed approach. The complications occurred to 16 patients with transpelvic approach and 9 patients with mixed approach, respectively, showing no significant difference between them ( χ2=0.11, P>0.05). Cases with postoperative anastomotic fistula, cases with anastomotic bleeding, cases with anastomotic stenosis, cases with intestinal obstruction, cases with incision infection, cases with urinary retention, cases with pelvic infection, cases with pulmonary infection, cases with incisional hernia, cases with chylous fistula, cases with abdominal and pelvic abscess were 5, 2, 1, 7, 0, 1, 5, 3, 1, 1, 1 for patients with transpelvic approach, versus 6, 3, 2, 2, 2, 1, 2, 3, 1, 1, 1 for patients with mixed approach, showing no significant difference between them ( P>0.05). The same patient could have multiple postoperative complications. (4) Follow-up. All the 90 patients were followed up for 27(range, 6?62)months. The follow-up time of 60 patients with transpelvic approach was 27(range, 8?62)months. The follow-up time of 30 patients with mixed approach was 28(range, 6?53)months. Of the 60 patients with transpelvic approach, 3 cases had local recurrence, 4 cases had liver metastasis, 3 cases had lung metastasis, and all of them survived with tumor. Of the 30 patients with mixed approach, 1 case had local recurrence, 2 cases had liver metastasis, 1 case had lung metastasis, and all of them survived with tumor. There was no death. The 3-year disease-free survival rates of patients with transpelvic approach and mixed approach were 84.7% and 87.9%, respectively, showing no significant difference between them ( χ2=0.39, P>0.05). Conclusions:Lapa-roscopic assisted ISR via transpelvic approach or mixed approach for low rectal cancer are safe and feasible. Compared with transanal mixed approach, the transpelvic approach of laparoscopic-assisted ISR has shorter operation time, less volume of intraoperative blood loss and longer distance from the postoperative anastomosis to anal margin.

Controversy and consensus of laparoscopic pylorus-preserving gastrectomy for early gastric cancer / 中华消化外科杂志

In recent years, the detection rate of early gastric cancer in China has increased. Early gastric cancer has a good prognosis, and how to further improve the postoperative quality of life for patients has become an increasingly concerned problem in the treatment of early gastric cancer. Therefore, function preserving gastrectomy has emerged. Function preserving gastrectomy aims to reduce the resection scope and preserve part of the gastric function on the premise of radical tumor resection. As a representative of function preserving gastrectomy, pylorus-preserving gastrec-tomy is suitable for early gastric cancer in middle segment. Compared with distal gastrectomy, laparoscopic pylorus-preserving gastrectomy not only has the advantage of less trauma, but also can reduce the incidence of postoperative dumping syndrome, bile reflux gastritis and gallstones, and improve postoperative nutritional status. However, the practice of pylorus-preserving gastrectomy is still in controversial. Based on the new Japanese guidelines for the treatment of gastric cancer, and combined with the latest domestic and foreign research trends and relevant evidence-based medicine basis, the authors review the definition and indications, safety, advantages, technical points, digestive tract reconstruction methods, postoperative complications and other aspects of laparoscopic pylorus-preserving gastrectomy.

Clinical efficacy between modified Overlap anastomosis and traditional auxiliary incision anastomosis in laparoscopic total gastrectomy / 中华消化外科杂志

Objective:To intestigate the clinical efficacy between modified Overlap anastomosis and traditional auxiliary incision anastomosis in laparoscopic total gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 115 patients with gastric cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were collected. There were 62 males and 53 females, aged from 27 to 83 years, with a median age of 62 years. Of 115 patients, 51 patients undergoing totally laparoscopic total gastrectomy with modified Overlap anastomosis using linear stapler were divided into modified Overlap group and 64 patients undergoing laparoscopic assisted total gastrectomy with traditional auxiliary incision anastomosis using circular stapler were divided into traditional assisted group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) anastomotic complications; (4) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detected tumor recurrence and survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ranked data was analyzed using the rank sum test. Results:(1) Surgical situations: the operation time, time of esophagojejunostomy, volume of intraoperative blood loss, the number of lymph node dissected, length of proximal incisional margin and length of auxiliary incision of the modified Overlap group were (234.0±11.0)minutes, (29.4±2.1)minutes, (53±14)mL, 42±13, (2.0±0.3)cm and (5.1±0.4)cm, respectively. The above indicators of the traditional assisted group were (231.0±11.0)minutes, (29.2±2.2)minutes, (50±13)mL, 40±10, (2.2±0.4)cm and (8.2±0.4)cm, respectively. There was significant difference in the length of auxiliary incision between the two groups ( t=-43.098, P<0.05), and there was no significant difference in the operation time, time of esophagojejunostomy, volume of intraoperative blood loss, the number of lymph node dissected, length of proximal incisional margin between the two groups ( t=1.168, 0.460, 0.990, 1.127, -1.926, P>0.05). (2) Postoperative situations: cases with mild, moderate, severe pain (postoperative pain degree), time to first flatus, time to initial fluid diet intake, duration of postoperative hospital stay of the modified Overlap group were 40, 9, 2, (2.9±1.0)days, (4.8±2.2)days, (11.7±2.8)days, respectively. The above indicators of the traditional assisted group were 31, 27, 6, (3.9±1.4)days, (6.5±2.5)days, (13.0±3.1)days, respectively. There were significant differences in the above indicators between the two groups ( Z=-3.217, t= -4.344, -3.888, -2.261, P<0.05). (3) Anastomotic complications: cases with anastomotic leakage, cases with anastomotic bleeding, cases with anastomotic stenosis of the modified Overlap group were 1, 1, 0, respectively. The above indicators of the traditional assisted group were all 1. There was no significant difference in the above indicators between the two groups ( P>0.05). Cases with anastomotic leakage were cured after the treatment of enteral nutritional support through nasogastric catheterization, which were confirmed by gastroenterography. Cases with anastomotic bleeding were improved by active hemostatic therapy. Cases with anastomotic stenosis were improved after the symptomatic treatment of anti-inflammatory and anti-swelling. (4) Follow-up: 109 of the 115 patients were followed up. Forty-eight of 51 patients in the modified Overlap group were followed up for 15.0-45.0 months, with a median follow-up time of 33.5 months. Sixty-one of 64 patients in the traditional assisted group were followed up for 16.0-46.0 months, with a median follow-up time of 27.0 months. There was no tumor recurrence in the modified Overlap group. One patient in the traditional assisted group had tumor recurrence with liver metastasis and survived with tumor. There was no significant difference in tumor recurrence rate between the two groups ( P>0.05). There was no patient died during the follow-up. Conclusion:Compared with traditional auxiliary incision anastomosis, patients undergoing total laparoscopic total gastrectomy with modified Overlap anastomosis have small incision, good postoperative recovery.

The application of adaptive statistical iterative reconstruction Veo in detection of pulmonary nodule by ultralow dose chest CT / 实用放射学杂志

Objective To explore the best percentage of adaptive statistical iterative reconstruction Veo (ASiR-V)in detection of pulmonary nodule by chest ultralow dose CT (ULDCT).Methods 81 patients with pulmonary nodule detected by chest low dose CT (LDCT)underwent a local ULDCT scan at the center of the nodule with a range of 3 cm scan length.LDCT was performed with the mode of the Assist kV (120/100 kV)/Smart mA with noise indices of 14.1 HU and reconstructed with ASiR-V 50% algorithm.ULDCT was acquired at a tube potential of 120 kV and tube current-time product of 2.8 mAs and reconstructed with ASiR-V 50%,70% and 90%algorithms.Subjective and obj ective image qualities,sensitivities of detection and diameter of nodule among all ULDCT images were compared.Results Compared with the radiation dose of LDCT [(0.9 9±0.3 6)mSv],a 90.2% decrease was seen with the ULDCT, for which the calculated mean effective radiation dose was (0.097±0.007)mSv.The noise values of fat and paravertebral muscle for ULDCT reconstructed with ASiR-V 90% were 12.33±1.86 and 14.82±2.6,which were significantly lower than those in the group of ASiR-V 50% (1 9.73±1.98, 21.19±2.46)and the group of ASiR-V 70% (15.79±1.82,17.71±2.50)(P＜0.05).The subjective scores of images reconstructed with ASiR-V 70% (4.13±0.47)were the highest,which were slightly higher than those in 90%groups (4.03±0.38)(P＜0.05).No significant differences for overall sensitivity of nodule detection were observed among the ULDCT reconstructed with ASiR-V 50%(86.42%),ASiR-V 70%(87.04%)and ASiR-V 90% (88.89%)(P＞0.05).The mean nodule diameter measurements were (6.4±2.0)mm,(5.9±2.2)mm,(6.0±2.2)mm and (6.1 ±2.2)mm for LDCT and ULDCT (ASiR-V 50%,70% and 90%),respectively with P＞0.05.Conclusion At extremely low exposure levels,ASiR-V can obviously improve the image qualities of ULDCT,and 90% is the best percentage for lung algorithm reconstruction with a high sensitivity of pulmonary nodule detection.

Effect of Yanghe decoction serum on the proliferation of breast cancer stem cells / 国际中医中药杂志

Objective To investigate the effect of Yanghe decoction serum on the proliferation of breast cancer stem cells HMLER90hi and its mechanism. Methods Twenty female Sprague-Dawley rats were randomly divided into low,medium and high dose groups containing drug serum and control group, in order to prepare the Yanghe decoction serum and blank serum. After 24 hours of drug intervention,the effects of each group on the proliferation of HMLER90hi cells at 24 h,48 h,and 72 h were detected by MTT assay. The expression of EphA4 and p50 mRNA in each group were detected by real-time fluorescence quantitative PCR. Results Compared with the blank control group,the cell proliferation activity of each dose group of Yanghe decoction significantly decreased at 24 h (0.818 ± 0.061, 0.706 ± 0.073, 0.587 ± 0.052 vs. 0.928 ± 0.075), 48h (0.760 ± 0.047, 0.638 ± 0.056, 0.510 ± 0.059 vs. 0.973 ± 0.095), and 72 h (0.672 ± 0.102, 0.508 ± 0.092, 0.448 ± 0.048vs.1.023 ± 0.099) (P<0.05 orP<0.01), respectively. After 24 h of drug intervention, compared with the control group, the expression of EphA4 mRNA (0.54 ± 0.07, 0.54 ± 0.07, 0.33 ± 0.04 vs.0.68 ± 0.09) significantly decreased, and p50 mRNA (0.69 ± 0.10, 0.54 ± 0.08, 0.41 ± 0.06vs. 0.85 ± 0.13) significantly decreased in each dose group of Yanghe decoction (P<0.05 orP<0.01).ConclusionsTheYanghe decoction can inhibit the proliferation of breast cancer stem cell HMLER90hi,and its mechanism may be related to its inhibition of the conduction of the juxtacrine pathway of monocyte macrophage.

Anatomic analysis of the right colonic vessels in the laparoscopic right hemicolectomy / 中华消化外科杂志

Objective To analyze the anatomy of the right colonic vessels in the laparoscopic right hemicolectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 60 patients who underwent laparoscopic right hemicolectomies in the Second Affiliated Hospital of Fujian Medical University from March 2013 to October 2016 were collected.All the patients used central approach.Patients intraoperatively underwent complete mesocolic excision (CME),and vascular anatomies of the right colon were precisely distinguished through postoperatively observing video.The starting position,formation and relative spatial location of vessels were counted and analyzed,and video screenshots were used as a comments during analysis.Observation indicators:(1) superior mesenteric artery (SMA) and superior mesenteric vein (SMV):occurrence rate and relative spatial location;(2) ileocolic artery and vein:occurrence rate and relative spatial location;(3) right colonic artery and vein:occurrence rate and relative spatial location of right colonic artery,occurrence rate and distribution of right colonic vein flowed into superior vein;(4) gastrocolic venous trunk:occurrence rate and composition of the branches;(5) middle colonic artery and vein:occurrence rate and relative spatial location of middle colonic artery,occurrence rate and distritution of middle colonic vein flowed into superior vein.Measurement data were represented as proportion and percentage.Results (1) SMA and SMV:all the 60 patients appeared SMA and SMV,with an occurrence rate of 100.0％(60/60).Of 60 patients,95.0％(57/60) and 5.0％(3/60) patients' SMAs respectively were located on the left side and right side of SMVs.(2) Ileocolic artery and vein:of 60 patients,the occurrence rates of ileocolic artery and vein were 96.7％ (58/60) and 100.0％ (60/60).Relative spatial location:of 58 patients with ileocolic artery,8.6％ (5/58),31.0％ (18/58),10.3％ (6/58),6.9％(4/58),32.9％(19/58) and 10.3％(6/58) patients' ileocolic arteries were respectively located on the right ahead,anterosuperior,inferoanterior,right behind,upper posterior and lower posterior of ileocolic veins;50.0％(29/58) patients' ileocolic arteries crossed from the front of SMV,and 50.0％ (29/58) patients' ileocolic arteries ran behind the SMV.(3) Right colonic artery and vein:① Right colonic artery:of 60 patients,occurrence rate was 55.0％(33/60),including 93.9％(31/33) with 1 right colonic artery and 6.1％(2/33) with 2 right colonic arteries.A trunk made of right colonic artery and middle colonic artery was detected in 24.2％ (8/33) patients,and flowed into SMA,including 2/8 patients with 2 right colonic arteries and 6/8 with 1 right colonic artery.Relative spatial location:of 33 patients,90.9％ (30/33) occurred right colonic artery crossed from the front of SMV;9.1％ (3/33) occurred SMA located on the right side of SMV that led to no relative spatial location between right colonic artery and SMV.② Right colonic vein:of 60 patients,occurrence rate was 93.3％ (56/60),including 87.5％(49/56) with 1 right colonic vein (7 were accompanied by right colonic artery) and 12.5％ (7/56) with 2 right colonic veins.Distribution of right colonic vein flowed into superior vein:of 49 patients with 1 right colonic vein,right colonic vein respectively flowed into gastrocolic venous trunk and SMV were detected in 73.5％ (36/49) and 26.5％ (13/49) patients.Of 7 patients with 2 right colonic veins,right colonic vein flowed into SMV and gastrocolic venous trunk were detected respectively in 6/7 patients and 1/7 patients.(4) Gastrocolic venous trunk:occurrence rate was 88.3％ (53/60);11.7％ (7/60) patients had absence of gastrocolic venous trunk,and right gastric epiploic vein directly flowed into SMV.Composition of the branches of gastrocolic venous trunk:of 53 patients,3-branch or 4-branch stomach-pancreas-colon venous trunk in 54.7％ (29/53) patients was made up of right gastric epiploic vein,pancreaticoduodenal vein,right colonic vein and middle colonic vein;2-branch or 3-branch gastrocolic venous trunk in 35.9％ (19/53) patients was made up of right gastric epiploic vein,right colonic vein and middle colonic vein;2-branch stomach-pancreas venous trunk in 9.4％ (5/53) patients was made up of right gastric epiploic vein and pancreaticoduodenal vein.(5) Middle colonic artery and vein:① Middle colonic artery:60 patients appeared middle colonic artery,with an occurrence rate of 100.0％ (60/60) and 1.7％ (1/60) appeared 2 middle colonic arteries.Of 60 patients,13.3％ (8/60) patients' middle colonic artery shared the same trunk together with right colonic artery that flowed into 1 middle colonic artery,and 85.0％(51/60) appeared 1 middle colonic artery.Middle colonic artery ≤ 1 cm,from 1 to 2 cm (excluding 1 cm) and ＞2 cm occurred branch at running out of neck of pancreas were detected in 15.7％ (8/51),66.7％ (34/51) and 66.7％ (34/51)patients,respectively.② Middle colonic vein:56 of 60 patients appeared middle colonic vein,with an occurrence rate of 93.3％(56/60),and 80.3％(45/56),16.1％(9/56) and 3.6％(2/56) patients appeared respectively 1,2 and 3 middle colonic veins.Distribution of middle colonic vein flowed into superior vein:45 patients appeared 1 middle colonic vein,55.6％ (25/45) and 44.4％ (20/45) middle colonic veins respectively flowed into SMV and gastrocolic venous trunk;9 patients appeared 2 middle colonic veins,7/9 middle colonic veins flowed into SMV and gastrocolic venous trunk and 2/9 middle colonic veins flowed into SMV;2 patients appeared 3 middle colonic veins,1 and 2 middle colonic veins respectively flowed into gastrocolic venous trunk and SMV.Conclusion Vascular anatomical variations of the right colon are complex in the laparoscopic right hemicolectomy,and anatomies of the surgical thunk and Helen trunk are difficult and core issue in operation.

Comparison of diagnostic value between DR and MSCT in fracture and dislocation of foot and ankle / 中国骨伤

<p><b>OBJECTIVE</b>To compare the diagnostic value between digital photography (DR) and multi-slice spiral CT (MSCT) in fracture and dislocation of foot and ankle.</p><p><b>METHODS</b>From August 2010 to August 2012, the DR and MSCT data of 52 patients with fracture and dislocation of foot and ankle were compared according to results of surgery or discharge diagnosis. There were 37 males and 15 females, aged from 15 to 49 years old. Wilcoxon signed rank test was used for statistical analysis.</p><p><b>RESULTS</b>The results of 52 cases of MSCT were matched with the postoperative or discharge diagnosis. A total of 172 fractures were found on MSCT and 98 fractures were found on DR, the results had significant difference in detecting fracture (V=1 081, P<0.05); A total of 24 dislocations were found on MSCT and 16 dislocations were found on DR,the results also had significant difference in detecting dislocation (V=21, P<0.05). Fractures of 6 cases with DR diagnosis were corrected and located by MSCT.</p><p><b>CONCLUSION</b>MSCT is significantly better than DR in diagnosis of fracture and dislocation of foot and ankle. The examination of two parts should be performed in DR. MSCT and multi-planar reconstruction (MPR) examination should be further performed if DR results are unclear or do not match with clinical symptoms, missed diagnosis and misdiagnosis can be avoided.</p>

Relationship between white blood cell count, neutrophils ratio and erythrocyte sedimentation rate and short clinical outcomes among patients with acute ischemic stroke at hospital admission / 中华流行病学杂志

Objective To investigate the relationship between white blood cell count,neutrophils ratio and erythrocyte sedimentation rate and short outcomes among patients with acute ischemic stroke at admission to the hospital.Methods A total of 2675 acute ischemic stroke patients were included in this study.Data on demographic characteristics,life style,history of disease,white blood cell count( WBC),neutrophils ratio(NEUR),erythrocyte sedimentation rate(ESR) and clinical outcomes were collected for all the participants.Poor clinical outcome was defined as neurologic deficiency (NIHSS≥5) at discharge or death during hospitalization.Results White blood cell count,neutrophils ratio and erythrocyte sedimentation rate were higher in patients with poor outcome than m those without clinical outcome.According to the quartile range,WBC,NEUR and ESR were divided into four levefs at admission.After adjustment for multivariate,compared with WBC≤5.6 × 109/L,the odds ratio (95％ confidence intervals) of poor outcome with ≥8.7 × 109/L was 1.883 (1.306-2.716).When compared with NEUR≤0.56,the odds ratio (95％ confidence intervals) of poor outcome with 0.57-0.64 and with ≥0.74 were 1.572 (1.002-2.466) and 2.577 ( 1.698-3.910),respectively.When compared with ESR≤4 mm/h,the odds ratio (95％ confidence intervals) of poor outcome with ≥17 mm/h was 2.426 (1.233-4776).Elevated WBC count and NEUR at admission were significantly and positively associated with poor clinical outcomes among patients with acute ischernic stroke (trend test P＜0.05).Elevated ESR was not significantly or positively associated with poor clinical outcomes among patients with acute ischemic stroke (trend test P＞0.05).Conclusion There appeared associations between WBC,NEUR,ESR and poor outcome among patients with acute ischemic stroke at admission to the hospital.Both elevated WBC count and NEUR showed significantly positive association with poor clinical outcomes among patients with acute ischemic stroke at admission.

No-reflow protection and long-term efficacy for acute myocardial infarction with Tongxinluo: a randomized double-blind placebo-controlled multicenter clinical trial (ENLEAT Trial) / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>No-reflow after emergency percutaneous coronary intervention (PCI) for acute ST segment elevation myocardial infarction (STEMI) is related to the severe prognosis. The aim of this study was to evaluate the efficacy of Tongxinluo, a traditional Chinese medicine, on no-reflow and the infarction area after emergency PCI for STEMI.</p><p><b>METHODS</b>A total of 219 patients (female 31, 14%) undergoing emergency PCI for STEMI from nine clinical centers were consecutively enrolled in this randomized, double-blind, placebo-controlled, multicenter clinical trial from January 2007 to May 2009. All patients were randomly divided into Tongxinluo group (n = 108) and control group (n = 111), given Tongxinluo or placebo in loading dose 2.08 g respectively before emergency PCI with aspirin 300 mg and clopidogrel 300 mg together, then 1.04 g three times daily for six months after PCI. The ST segment elevation was recorded by electrocardiogram at hospitalization and 1, 2, 6, 12, 24 hours after coronary balloon dilation to evaluate the myocardial no-flow; myocardial perfusion scores of 17 segments were evaluated on day 7 and day 180 after STEMI with static single-photon emission computed tomography (SPECT) to determine the infarct area.</p><p><b>RESULTS</b>There was no statistical significance in sex, age, past history, chest pain, onset-to-reperfusion time, Killip classification, TIMI flow grade just before and after PCI, either in the medication treatment during the follow up such as statin, β-blocker, angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) between two groups. There was significant ST segment restoration in Tongxinluo group compared to the control group at 6 hours ((-0.22 ± 0.18) mV vs. (-0.18 ± 0.16) mV, P = 0.0394), 12 hours ((-0.24 ± 0.18) mV vs. (-0.18 ± 0.15) mV, P = 0.0158) and 24 hours ((-0.27 ± 0.16) mV vs. (-0.20 ± 0.16) mV, P = 0.0021) reperfusion; and the incidence of myocardial no-reflow was also reduced significantly at 24-hour reperfusion (34.3% vs. 54.1%, P = 0.0031). The myocardial perfusion scores of 17 segments evaluated by static SPECT was improved significantly on day 7 and day 180 after STEMI in Tongxinluo group compared to the control group (0.61 ± 0.40 vs. 0.76 ± 0.42, P = 0.0109 and 0.51 ± 0.42 vs. 0.66 ± 0.43, P = 0.0115, respectively). There was no significant difference in severe adverse events between two groups.</p><p><b>CONCLUSION</b>Tongxinluo as a kind of traditional Chinese medicine could reduce myocardial no-reflow and infarction area significantly after emergency PCI for STEMI with conventional medicine therapy.</p>

Transcatheter closure of ruptured sinus of valsalva aneurysm using Amplatzer duct occluder / 中华心血管病杂志

<p><b>OBJECTIVE</b>The present study was conducted to investigate the feasibility and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm (RSVA).</p><p><b>METHODS</b>Four patients (3 females) aged 7-57 years with RSVA (3 congenital RSVA and 1 post-surgery RSVA) were involved in the present study. Two-dimensional and color Doppler echocardiography revealed the ruptures of right coronary sinus into right ventricle in all cases. The echo estimated size of the defect was 2-10 mm. After the establishment of the arterio-venous wire loop, Amplatzer Duct Occluder (ADO) was successfully deployed by antegrade venous approach in all patients. The diameter of the occluder was chosen to be at least 1 to 2 mm larger than defect.</p><p><b>RESULTS</b>The defects were successfully occluded without any complications. On the follow-up 3 months after operation, there was no device embolization, infective endocarditis and aortic regurgitation.</p><p><b>CONCLUSION</b>Transcatheter closure is a feasible and effective modality for RSVA without other anomalies.</p>

Humoral immune response elicited by plasmid DNA containing HGV E2 gene fragment / 生物工程学报

In order to study the feasibility of E2 gene fragment of hepatitis virus G(HGV) as a component of DNA vaccine against the hepatitis virus G infection, a 559bp DNA fragment encoding HGV E2 was cloned into plasmid pCMV-S from pThioHis-E2 in the same reading frame with HBsAg gene to form a recombinant plasmid named pCMV-S-E2. BALB/c mice of Kunming strain were immunized with purified plasmid DNA of pCMV-S-E2 by intra-muscularly inoculation. The immunizations were boosted twice at an interval of 14 days. The whole blood was collected from mice orbit on the day-8 after the last boost. Mice sera were screened by ELISA to determine the humoral immune response using E2-GST fusion protein as the immobilized antigen and the sera from mice immunized with pCMV-S as control. The result indicated that the immunization with plasmid DNA of pCMV-S-E2 could induce quite strong humoral immune response.

Expression of a DNA fragment encoding the active domain of human TNF related apoptosis inducing ligand in pichia pastoris / 生物工程学报

Human tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) is a member of the tumor necrosis factor (TNF) family of ligands which has been reported in 1995. The TRAIL protein induces apoptosis of certain types of target cells, such as transformed cells that include but are not limited to cancer cells and virus-infected cells but the normal cells. It is a type II transmembrane protein and the extracellular domain of TRAIL is the functional domain in induction of cell apoptosis. A gene fragment encoding for the active domain of TRAIL was modified with oligo-nucleotide directed mutagenesis according to the characters of Pichia pastoris expressing vector. Arginine at the position of 149 corresponding to the amino acid residue 531 which might be a potential Kex2 protease processing sites was substituted with Lysine to prevent the expressed protein from the digestion by the protease. After proved with DNA sequencing. the modified gene fragment coding soluble TRAIL domain was inserted into the Pichia pastoris expression vector pPIC9K in the same reading frame with alpha-factor secreting signal peptide. The recombinant plasmid pPIC9K - TRAIL was transferred into P. pastoris cell by spheroplast transformation. The recombinant yeasts were identified by antibiotic G418 and Southern dot blot. The transformants (His+ Mut(s)) containing multi-copy gene fragment of TRAIL were selected with increasing concentration of G418 and induced with 0.5% methanol in shaking flask to expression the active domain of TRAIL. After inducing for 3 - 4 days, the proteins in the culture supernatant was assayed with SDS-PAGE and Western blot. Two expressed protein bands whose appearant molecular weight were 19kD and 38kD, respectively, could be specifically recognized by polyclonal antibodies against human TRAIL. The 38kD protein might be a dimers of TRAIL in the culture supernatant. The amount of expressed foreign protein made up to 36% of the total proteins in the culture suprenatant. Biological activity assay, in vitro, indicated that the expressed protein could induce tumor cells apoptosis.

Expression and characterization of envelope protein 2 gene of hepatitis G virus in Pichia pastoris / 生物工程学报

A cDNA fragment locating at the putative envelop protein 2(E2) region of GBV-C/HGV fused with Schistosoma japonicum, glutathione S-transferase(GST) was amplified with PCR from plasmid pGEX-E2. The amplified DNA fragment was inserted into plasmid pGEX-5X-1, at the downstream of the coding sequences of GST, in the same reading frame with the gene of GST. The fusion gene fragment of GST-E2 was amplified with PCR, using the recombinant plasmid pGEX-5X-1-E2 as the template. The amplified 1324 bp DNA fragment of GST-E2 was inserted into Pichia pastoris expression vector pPIC9K in reading frame with alpha-factor secreting signal peptide. The plasmid pPIC9K-GST-E2 was transformed into Pichia pastoris GS115 with electroporation. The transformants (His+ Muts) were selected and induced to express the 54kD GST-E2 fusion protein, which could be specially recognized by both the antisera directed against E2 and against GST. The GST-E2 fusion protein was purified with Sepharose 4B glutathione affinity chromatography to a purity of 95%. The expression was optimized to achieve the highest expression level of GST-E2 fusion protein which was accumulated up to 50% of total proteins in the culture supernatant. The GST-E2 protein derived from the recombinant Pichia pastoris was proved possessing antigenicity and high specificity by ELISA, probed with sera from the patients infected by GBV-C/HGV.