Risk factors for 30-day unplanned reoperation after pancreatoduodenectomy: A single-center experience

Objective: The purpose of this study was to investigate the rate and reasons and also the risk factors for unplanned reoperation after pancreatoduodenectomy (PD) in a single center. Patients and Methods: This retrospective analysis included patients who underwent PD in the First Affiliated Hospital of Nanchang University between January 2010 and January 2018. The patients were divided into nonreoperation and reoperation groups according to whether they underwent unplanned reoperation following the primary PD. The incidence and reasons were examined. In addition, multivariate logistic regression analysis was performed to identify the risk factors for unplanned reoperation. Results: Of the 330 patients who underwent PD operations, 22 (6.67%) underwent unplanned reoperation. The main reasons for reoperation were postpancreaticoduodenectomy hemorrhage (PPH) (12/22 [54.5%]) and pancreaticoenteric anastomotic (PEA) leak (5/22 [22.7%]). Multivariate logistic regression analyses identified that diabetes (odds ratio [OR], 3.70; 95% confidence interval [CI], 1.06–12.90; P = 0.04), intraoperative blood loss ≥400 mL (OR, 4.06; 95% CI, 1.29–12.84; P = 0.02), occurrence of postoperative complications in the form of PPH (OR, 30.67; 95% CI, 8.85–106.31; P < 0.001), and PEA leak (OR, 11.53; 95% CI, 3.03–43.98, P < 0.001) were independent risk factors for unplanned reoperation. Conclusions: Our results suggest that diabetes, intraoperative blood loss ≥400 mL, PPH, and PEA leak were independent risk factors for unplanned reoperation after primary PD

Potential involvement of abnormal increased SUMO-1 in modulation of the formation of Alzheimer's disease senile plaques and neuritic dystrophy in APP/PS1 transgenic mice / 生理学报

Small ubiquitin-related modifiers (SUMOs) belong to an important class of ubiquitin like proteins. SUMOylation is a post-translational modification process that regulates the functional properties of many proteins, among which are several proteins implicated in neurodegenerative diseases. This study was aimed to investigate the changes of SUMO-1 expression and modification, and the relationship between SUMO-1 and Alzheimer's disease (AD) pathology in APP/PS1 transgenic AD mice. Using Western blot, co-immunoprecipitation and immunofluorescent staining methods, the SUMO-1 expression and modification and its relation to tau, amyloid precursor protein (APP) and β-amyloid protein (Aβ) in the 12-month-old APP/PS1 transgenic AD mice were analyzed. The results showed that: (1) Compared with the normal wild-type mice, the expression and modification of SUMO-1 increased in brain of AD mice, which was accompanied by an increase of ubiquitination; (2) In RIPA soluble protein fraction of cerebral cortex, co-immunoprecipitation analysis showed tau SUMOylated by SUMO-1 increased in AD mice, however, AT8 antibody labeled phosphorylated tau was less SUMOylated whereas PS422 antibody labeled phosphorylated tau was similar to control mice; (3) Double immunofluorescent staining showed that SUMO-1 could distributed in amyloid plaques, appearing that some of SUMO-1 diffused in centre of some plaques and some of SUMO-1 co-localized with AT8 labeled phosphorylated tau forming punctate aggregates around amyloid plaques which was concerned as dystrophic neurites, however, less Aβ, APP and PS422 labeled phosphorylated tau were found co-localized with SUMO-1. These results suggest that SUMO-1 expression and modification increase abnormally in transgenic AD mice, which may participate in modulation of the formation of senile plaques and dystrophic neurites.

Hand and wrist bone maturation in children with central precocious puberty and idiopathic short stature / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the maturation of individual bones on the hand and wrist in children with central precocious puberty (CPP) and idiopathic short stature (ISS).</p><p><b>METHODS</b>Hand and wrist films of 25 children with CPP, 29 children with ISS and 21 normal controls were evaluated by conventional Greulich-Pyle (GP) atlas method and individual bone assessment method, in which all twenty bones of the hand and wrist were evaluated based on GP atlas, including 2 radius and ulna, 7 carpal bones, 11 metacarpal and phalangeal bones, the average bone age (BA) was calculated. The differences in groups were analyzed by independent samples t test. The differences between the two methods were analyzed by paired sample t test. The differences between BA and chronological age (CA) were analyzed by ROC with SPSS 17.0.</p><p><b>RESULTS</b>Compared with the normal control group, the advance of BA in the CPP group was 0.70-2.26 y (1.48 ±0.78) by the GP atlas method, while that was 0.28-2.00 y(1.14 ±0.86) by the individual bone evaluation method. In all twenty bones, the advance of metacarpal and phalangeal BA was the greatest [0.34-2.06 y(1.2±0.86)]. In the ISS group,the delay of BA was 0.47-2.91 y(-1.69±1.22) by the GP atlas method, while that was 0.48-2.50 y (-1.49±1.01) by individual bone evaluation method.The delay of carpal BA was the greatest [0.59-2.73 y(-1.66±1.07)] in all twenty bones. In the ISS group and the normal control group, there were no statistic differences between the two methods. In the CPP group, statistic difference was found between two methods. There were no statistic differences for the areas under ROC curves between two methods.</p><p><b>CONCLUSION</b>The advance of metacarpal and phalangeal BA is the greatest in CPP group and the delay of carpal BA is the greatest in ISS group.Both methods provide diagnostic information for bone age in CPP and ISS children.</p>

Developmental changes in the expression of Kiss1 gene and estrogen receptor α gene in hypothalamus of female Sprague-Dawley rats / 中华实用儿科临床杂志

Objective To investigate the function of Kiss1 gene and estrogen receptor α gene (ERα gene) in puberty of rats,by detecting the expressions of Kiss1 mRNA and ERα mRNA in the hypothalamus and the serum luteinizing hormone (LH) and estradiol (E2) level of female Sprague-Dawley (SD) rats at various stage of development with Real-time PCR and enzyme-linked immunosorbent assay(ELISA).Methods Thirty-five female SD rats of 3 days were weaned on postnatal(PND)22 and then the vaginal opening condition was observed daily.The rats were sacrificed at PND 15(juvenile group,n =19) and PND 35 (pubertal group,n =16).The hypothalamus were segregated and the serum were extracted from heart blood.All of the samples were stored at-80 ℃ prepared.Then the mRNA were extracted from the hypothalamus and the cDNA obtained by reverse transcription were tested with real-time PCR.The relative mRNA expression level of Kiss1 gene and ERα gene were calculated.Results 1.Entire level:it was found that the pubertal group vaginal opening time was (32.1 ± 1.0) days,while the juvenile group was not found with vaginal opening until sacrificed.2.Real-time PCR:the expressions of Kiss1 and ERα gene were significantly increased in pubertal group (Kissl gene:5.39-± 2.52,ERα gene:1.57 ±1.87) compared with juvenile group(Kiss1 gene:1.06 ± 1.09,ERα gene:0.59-± 0.68),and the differences were statistically significant (all P ＜ 0.001).3.ELISA:the serum LH and E2 in pubertal group [LH (11.61 ± 0.95) IU/L,E2 (167.53 ± 31.09) ng/L] were significantly higher than LH [(5.46-± 1.89)IU/L] and E2 [(58.59 ± 29.96) ng/L] in juvenile group,and the differences were statistically significant (all P ＜0.001).Conclusion Kiss1 gene and ERα gene are involved in the start of the sexual development of female SD rat.

Comparative study on irritable bowel syndrome treated with acupuncture and western medicine / 中国针灸

<p><b>OBJECTIVE</b>To compare the differences in the therapeutic effect on irritable bowel syndrome (IBS) between acupuncture at Tianshu (ST 25) and Dachangshu (BL 25) and western medication with Trimebutine Maleate.</p><p><b>METHODS</b>Forty cases were divided randomly into an acupuncture group and a western medication group, 20 cases in each one. In acupuncture group, acupuncture was applied to Tianshu (ST 25) and Dachangshu (BL 25). Ziwu Daojiu needling technique was adopted, once daily. In western medication group, Trimebutine Maleate capsule was administered, 2 capsules in each time, 3 times per day. The assessment on the therapeutic effect was performed in 4 weeks of treatment in two groups.</p><p><b>RESULTS</b>As compared with those before treatment, the time of abdominal pain, the frequency of abdominal pain, the morbidity of abnormal stool appearance, the morbidity of defecation abnormality, the morbidity of mucus stool and the score of bloating or abdominal pain on bowel movement were all reduced after treatment in two groups (all P < 0.01). The results in acupuncture group were much more significant than those in western medication group (the total score: 16.70 +/- 2.40 vs 15.70 +/- 3.01, P < 0.01). The total effective rate in acupuncture group was 95.0% (19/20), which was superior to that of 70.0% (14/20) in western medication group (P < 0.05).</p><p><b>CONCLUSION</b>Acupuncture at Tianshu (ST 25) and Dachangshu (BL 25) may remarkably relieve the clinical symptoms of IBS and its efficacy is superior to that of oral medication with Trimebutine Maleate.</p>

Influence of Osteopontin Short Hairpin RNA on the Proliferation and Activity of Rat Vascular Smooth Muscle Cells / 华中科技大学学报（医学）（英德文版）

To investigate the influence of osteopontin (OPN) short hairpin RNA (shRNA) on the proliferation and activity of rat vascular smooth muscle cells (VSMCs),the expressing vector of shRNA targeting OPN was constructed and transferred into the rat VSMCs.After amplification and purification,pGenesil-1/OPNshRNA1 (PG1),pGenesil-1/OPNshRNA2 (PG2) and pGenesil-1/OPNshRNAHK (PGH) were transfected into the cultured rat VSMC by LipofectamineTM 2000.Transfected cells were visualized by using an inverted fluorescent microscope.VSMCs transfected by optimal recombined plasmid was selected by culturing in G418 48 h later.Nude cells and cells transfected by PGH were used as control.The expression levels of OPN mRNA and protein were assayed by RT-PCR and Western blotting.The OPN of VSMCs was suppressed by transfection of optimal recombined plasmid,and the changes in cell proliferation,adhesion and motility were evaluated by MTT,adhesion test and transwell chamber test.Levels of type Ⅰ and Ⅲ collagen were measured with ELISA kit.Our results showed that VSMCs stably transfected by OPN shRNA accounted for over 50% of total cells.OPN mRNA and protein were reduced by 81% and 67% (P<0.01) by PGI,73% and 52% (P<0.01) by PG2,respectively while no change was found in PGH and non-treated VSMCs.PG1 significantly suppressed the proliferation,adhesion,mobility of VSMCs and reduced the amount of type Ⅰ and Ⅲ collagen.It is concluded that recombinant plasmid can be successfully transfected into VSMCs by LipofectamineTM 2000 and inhibit the expression of OPN.The proliferation,adhesion and mobility of VSMCs can be inhibited by knocking down OPN expression.Moreover,the transferring capability of cells is attenuated,and the secretion of type Ⅰ and Ⅲ collagen is inhibited aftter knocking-down of OPN expression.The study provides experimental evidence for clinical prevention of restenosis after percutaneous coronary intervention (PCI) by RNA interference (RNAi) technology.

The preparation of anti-hnRNP A2/B1 polyclonal antibody and its application in non-small cell lung cancer / 肿瘤

Objective: To prepare anti-hnRNP A2/B1 polyclonal antibody and determine its clinical significance in diagnosis and prediction of non-small cell lung cancer and analyze the relationship between the expression of hnRNP A2/B1 and pathological features. Methods: HnRNP A2/B1 expression was induced by IPTG. The rabbit-anti-human hnRNP A2/B1 polyclonal antibodies were prepared and purified. The specimens were isolated from 45 cases of non small cell lung cancer tissues and paracancerous tissues and 16 cases of lung inflammatory pseudotumor tissues and embedded in paraffin. hnRNP A2/B1 expression was detected by immunohistochemical method using rabbit anti-human hnRNP A2/B1 polyclonal antibodies. The results were compared with imported anti-hnRNPA2/B1 monoclonal antibody to observe the clinical value of self-made polyclonal antibodies. Results: The rabbit anti-human hnRNPA2/B1 polyclonal antibody is successfully generated. The positive rate of hnRNP A2/B1 expression detected by anti-hnRNP A2/B1 polyclonal antibody was significantly higher in lung cancer tissues than that in paracancerous tissues (62.2% vs 40.0%, P = 0.035) and lung inflammatory pseudotumor tissues(62.2% vs 31.3%, P = 0.033). The overexpression of hnRNP A2/B1 was positively related with age and smoking and negatively related with differentiation degree. But it was not related to tumor histological classification, gender, lymph node metastasis, TNM stage, and distant metastasis. (4) The difference in survival time was significant between the two groups. hnRNP A2/B1-positive patients had shorter survival time than hnRNP A2/ B1-negative patients (P = 0.048). Conclusions: The rabbit anti-human hnRNP A2/B1 polyclonal antibody is successfully generated. Overexpression of hnRNP A2/B1 in lung cancer tissues has clinical values to a certain degree for diagnosis and prediction of the prognosis of lung cancer.

Thyroid autoantibodies in children with Turner's syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>Turner's syndrome (TS) is characterized by the absence of an X chromosome or the presence of a structurally abnormal X chromosome in a phenotypic female. It was recently reported that autoimmune thyroiditis (AIT) was found in 38% of white patients with TS, and few studies in this aspect have been conducted in China. The purpose of this study was to determine the frequency of AIT among TS patients and risk factors for development of thyroid dysfunction in Chinese children with TS.</p><p><b>METHODS</b>Serum antithyroglobulin antibody (TgAb), thyroperoxidase antibody (TPOAb) and thyroid function (T(3), T(4) and TSH) of 24 children with TS (mean age 12.9 +/- 2.4 years, range 4.8 - 16.8 years) were assessed. Their karyotype distribution was as follows: thirteen patients with 45, XO kayrotype, eight patients with structurally abnormal X chromosome, two with X mosaic kayrotype and one with 46, XX. Techniques including radioimmunoassy and elctro-chemiluminescence immunoassy were used in this study. All TS children were divided into two groups. Group one was thyroid autoantibodies (TAA)-positive group, the levels of TgAb and/or TPOAb in them were higher than the normal levels (TgAb < 30%, TPOAb < 20%), respectively, and the remaining patients were assigned into TAA-negative group.</p><p><b>RESULTS</b>Seven of the 24 (29%) patients had higher levels of TgAb and TPOAb than the normal values (< 30% and < 20%). The level of serum TSH [6.1 (3.6-100.0) mU/L] in TAA-positive group was significantly higher than that [3.9 (1.7-7.9) mU/L] in TAA-negative group (P < 0.05). The frequency of hypothyroidism or subclinical hypothyroidism in TAA-positive group (5/7) was higher than that in TAA-negative group (3/17) (P < 0.05).</p><p><b>CONCLUSION</b>The positive rate of serum TAA in children with TS was 29%. About 70% TS children with positive serum TAA developed hypothyroidism or subclinical hypothyroidism. The results have provided the basis for regular follow-up assessment of thyroid autoantibodies and thyroid function in children with TS, and these measures are of importance for timely diagnosis of thyroid dysfunction and application of appropriate treatment.</p>

Healthcare Reform should Prioritize Equality while Maintain Efficiency / 中国医学伦理学

By equality in the healthcare retorm we mean equal access to healthcare protection.Future reiorm should establish a fair value concept and make great efforts to solve the serious lack of fairness in the current healthcare system.Efficiency in the healthcare refers to not only higher revenue income of medical institutes but also to utmostly meet the citizens" needs for medical service.For the sake of the most cost - effective distribution of the insufficient budgets and medical resources,medical services have to be diversified for an improved efficiency. In the framework of the healthcare reform,relations between equality and efficiency is the unity of opposites,and top priority shall be given to equality while maintain efficiency.

Significance of ST/TP Relative Value in Electrocardiogram in Diagnosis of Hypocalcemia / 实用儿科临床杂志

Objective To evaluate the significance of ST/TP relative value in electrocardiogram in diagnosis of hypocalcemia.Methods ST/TP relative value in electrocardiogram in 61 children with hypocalcemia and 31 normal children were detected by NIHOH KOHDEN CardiofaxQ ECG-9130P electrocardiogram machine designed by Japanese futian company.Calcium ion was checked out by clinic electrolyte equipment.Results There was significant difference of ST/TP relative value between patients with hypocalcemia and normal children(P