Advances in tumor regression patterns and safe distance of distal resection margin after neoadjuvant therapy for rectal cancer / 中华胃肠外科杂志

Neoadjuvant therapy has been widely applied in the treatment of rectal cancer, which can shrink tumor size, lower tumor staging and improve the prognosis. It has been the standard preoperative treatment for patients with locally advanced rectal cancer. The efficacy of neoadjuvant therapy for rectal cancer patients varies between individuals, and the results of tumor regression are obviously different. Some patients with good tumor regression even achieve pathological complete response (pCR). Tumor regression is of great significance for the selection of surgical regimes and the determination of distal resection margin. However, few studies focus on tumor regression patterns. Controversies on the safe distance of distal resection margin after neoadjuvant treatment still exist. Therefore, based on the current research progress, this review summarized the main tumor regression patterns after neoadjuvant therapy for rectal cancer, and classified them into three types: tumor shrinkage, tumor fragmentation, and mucin pool formation. And macroscopic regression and microscopic regression of tumors were compared to describe the phenomenon of non-synchronous regression. Then, the safety of non-surgical treatment for patients with clinical complete response (cCR) was analyzed to elaborate the necessity of surgical treatment. Finally, the review studied the safe surgical resection range to explore the safe distance of distal resection margin.

Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases / 中华外科杂志

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ2 test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ2=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

Amygdalin Ameliorates Liver Fibrosis through Inhibiting Activation of TGF-β/Smad Signaling / 中国结合医学杂志

OBJECTIVE@#To observe the effect of amygdalin on liver fibrosis in a liver fibrosis mouse model, and the underlying mechanisms were partly dissected in vivo and in vitro.@*METHODS@#Thirty-two male mice were randomly divided into 4 groups, including control, model, low- and high-dose amygdalin-treated groups, 8 mice in each group. Except the control group, mice in the other groups were injected intraperitoneally with 10% carbon tetrachloride (CCl4)-olive oil solution 3 times a week for 6 weeks to induce liver fibrosis. At the first 3 weeks, amygdalin (1.35 and 2.7 mg/kg body weight) were administered by gavage once a day. Mice in the control group received equal quantities of subcutaneous olive oil and intragastric water from the fourth week. At the end of 6 weeks, liver tissue samples were harvested to detect the content of hydroxyproline (Hyp). Hematoxylin and eosin and Sirius red staining were used to observe the inflammation and fibrosis of liver tissue. The expressions of collagen I (Col-I), alpha-smooth muscle actin (α-SMA), CD31 and transforming growth factor β (TGF-β)/Smad signaling pathway were observed by immunohistochemistry, quantitative real-time polymerase chain reaction and Western blot, respectively. The activation models of hepatic stellate cells, JS-1 and LX-2 cells induced by TGF-β1 were used in vitro with or without different concentrations of amygdalin (0.1, 1, 10 µmol/L). LSECs. The effect of different concentrations of amygdalin on the expressions of liver sinusoidal endothelial cells (LSECs) dedifferentiation markers CD31 and CD44 were observed.@*RESULTS@#High-dose of amygdalin significantly reduced the Hyp content and percentage of collagen positive area, and decreased the mRNA and protein expressions of Col-I, α-SMA, CD31 and p-Smad2/3 in liver tissues of mice compared to the model group (P<0.01). Amygdalin down-regulated the expressions of Col-I and α-SMA in JS-1 and LX-2 cells, and TGFβ R1, TGFβ R2 and p-Smad2/3 in LX-2 cells compared to the model group (P<0.05 or P<0.01). Moreover, 1 and 10 µmol/L amygdalin inhibited the mRNA and protein expressions of CD31 in LSECs and increased CD44 expression compared to the model group (P<0.05 or P<0.01).@*CONCLUSIONS@#Amygdalin can dramatically alleviate liver fibrosis induced by CCl4 in mice and inhibit TGF-β/Smad signaling pathway, consequently suppressing HSCs activation and LSECs dedifferentiation to improve angiogenesis.

Clinicopathological characteristics and lymph node metastasis in patients with early gastric cancer / 中华普通外科杂志

Objective:To explore the risk factors of lymph node metastasis (LNM) in early gastric cancer (ECG), and establish a risk-prediction model based on LNM.Method:Four hundred and twenty-seven EGC patients undergoing curative radical gastrectomy were enrolled in this study. The risk factors for LNM of ECG were analyzed with Logistic regression. LNM risk was stratified and risk-predicting model was established. The risk-predicting model was measured by area under ROC curve. According to the same standard, clinical data of 133 patients with EGC who underwent radical surgery were selected for external verification of the model.Results:The frequency of LNM was 13.3% (32/427) in EGC patients. The LNM ratio of intramucosal carcinoma and submucosal carcinoma was 1.3% (3/237), 15.3% (29/190) respectively. Ulcer presence, tumor size >2 cm, undifferentiated tumor, submucosal invasion, neural invasion, and vascular tumor thrombus were significantly associated with LNM in EGC patients ( χ2=3.408, 16.379, 4.808, 29.804, 25.305, 47.120, respectively P<0.05). Multivariate analysis suggested that ulcer presence, tumor size >2 cm, depth of invasion, neural invasion, and vascular tumor thrombus were independent predictors of LNM in EGC patients, ( OR=0.326, 2.924, 11.824, 13.047, 7.756, respectively P<0.05). LNM predicting model is established, P=e

A prospective cohort study on the clinical value of pelvic peritoneal reconstruction in laparoscopic anterior resection for middle and low rectal cancer / 中华胃肠外科杂志

Objective: To investigate the safety and efficacy of pelvic peritoneal reconstruction and its effect on anal function in laparoscopy-assisted anterior resection of low and middle rectal cancer. Methods: A prospective cohort study was conducted. Consecutive patients with low and middle rectal cancer who underwent laparoscopy-assisted transabdominal anterior resection at Naval Military Medical University Changhai Hospital from February 2020 to February 2021 were enrolled. Inclusion criteria: (1) the distance from tumor to the anal verge ≤10 cm; (2) laparoscopy-assisted transabdominal anterior resection of rectal cancer; (3) complete clinical data; (4) rectal adenocarcinoma diagnosed by postoperative pathology. Exclusion criteria: (1) emergency surgery; (2) patients with a history of anal dysfunction or anal surgery; (3) preoperative diagnosis of distant (liver, lung) metastasis; (4) intestinal obstruction; (5) conversion to open surgery for various reasons. The pelvic floor was reconstructed using SXMD1B405 (Stratafix helical PGA-PCL, Ethicon). The first needle was sutured from the left anterior wall of the neorectum to the right. Insertion of the needle was continued to suture the root of the sigmoid mesentery while the Hemo-lok was used to fix the suture. The second needle was started from the beginning of the first needle, after 3-4 needles, a drainage tube was inserted through the left lower abdominal trocar to the presacral space. Then, the left peritoneal incision of the descending colon was sutured, after which Hemo-lok fixation was performed. The operative time, perioperative complications, postoperative Wexner anal function score and low anterior resection syndrome (LARS) score were compared between the study group and the control group. Three to six months after the operation, pelvic MRI was performed to observe and compare the pelvic floor anatomical structure of the two groups. Results: A total of 230 patients were enrolled, including 58 who underwent pelvic floor peritoneum reconstruction as the study group and 172 who did not undergo pelvic floor peritoneum reconstruction as the control group. There were no significant differences in general data between the two groups (all P>0.05). The operation time of the study group was longer than that of control group [(177.5±33.0) minutes vs. (148.7±45.5) minutes, P<0.001]. There was no significant difference in the incidence of perioperative complications (including anastomotic leakage, anastomotic bleeding, postoperative pneumonia, urinary tract infection, deep vein thrombosis, and intestinal obstruction) between the two groups (all P>0.05). Eight cases had anastomotic leakage, of whom 2 cases (3.4%) in the study group were discharged after conservative treatment, 5 cases (2.9%) of other 6 cases (3.5%) in the control group were discharged after the secondary surgical treatment. The Wexner score and LARS score were 3.1±2.8 and 23.0 (16.0-28.0) in the study group, which were lower than those in the control group [4.7±3.4 and 27.0 (18.0-32.0)], and the differences were statistically significant (t=-3.018, P=0.003 and Z=-2.257, P=0.024). Severe LARS was 16.5% (7/45) in study group and 35.5% (50/141) in control group, and the difference was no significant differences (Z=4.373, P=0.373). Pelvic MRI examination 3 to 6 months after surgery showed that the incidence of intestinal accumulation in the pelvic floor was 9.1% (3/33) in study group and 46.4% (64/138) in control group (χ(2)=15.537, P<0.001). Conclusion: Pelvic peritoneal reconstruction using stratafix in laparoscopic anterior resection of middle and low rectal cancer is safe and feasible, which may reduce the probability of the secondary operation in patients with anastomotic leakage and significantly improve postoperative anal function.

Enhanced Autophagy Suppresses Proplatelet Formation in Pediatric Immune Thrombocytopenia / 中国实验血液学杂志

OBJECTIVE@#To investigate the effect of enhanced autophagy in megakaryocyte to proplatelet formation in children with immune thrombocytopenia(ITP).@*METHODS@#Giemsa staining and immunofluorescence staining were used to observe megakaryocyte morphology and proplatelet formation, Western blot was used to determine the expression of cytoskeleton protein and autophagy related protein. Autophagr regulation drugs Rap or 3-MA was used to regulate autophagy of megakaryocytes.@*RESULTS@#Some vacuole-like structures was found in ITP megakaryocytes of the children, the expression of LC3II/I (ITP 1.32±0.18； Ctrl 0.49±0.16，P<0.05) and Atg5-Atg12 (ITP 0.69±0.17； Ctrl 0.12±0.08，P<0.05) was significantly higher in ITP children as compared with those in control group. The immu- nofluorescence staining showed that the cytoskeleton arrangement in megakaryocytes of ITP children was abnormal, and the phosphorylation of myosin light chain was also increased(ITP 0.74±0.09, Ctrl 0.05±0.02，P<0.05). In vitro, inducer or inhibitor of autophagy could regulate the production of proplatelet and the expression of cell cycle related protein, including CyclinD1（Veh 1.08±0.12; Rap 0.46±0.04; Rap+3-MA 0.70±0.03）, CyclinD2（Veh 0.47±0.04; Rap 0.27±0.04; Rap+3-MA 0.41±0.03）, P21（Veh 0.15±0.01; Rap 0.04±0.01; Rap+3-MA 0.05±0.01）.@*CONCLUSION@#Enhanced autophagy is the key factor of poor proplatelet formation in megakaryocytes of ITP children.

Effect of specific small interfering RNA against KLF11 expression on proliferation and apoptosis of human gastric cancer cell line BGC823 via Wnt/β-catenin signaling pathway / 中华普通外科杂志

Objective:To investigate the expression of KLF11 in gastric cancer tissues and cell lines as well as its effect on proliferation and apoptosis of human gastric cancer cells BGC823.Methods:Sixty pairs gastric cancer tissues and corresponding adjacent tissues were collected. The expression of KLF11 mRNA in gastric cancer tissues and their adjacent tissues was detected by RT-PCR. The expression of KLF11 was detected in gastric cancer cells. KLF11 expression was silenced. The proliferation of cells were detected by using MTT assay. Flow cytometry was used to detect the cell cycle and cell apoptosis rate. Western bloting was used to examine the changes of concentration of proteins associated with cell cycle,cell apoptosis and Wnt/β-catenin signaling pathway related proteins. The activity of Caspase3 enzyme was detected by spectrophotometry.Results:The relative expression of KLF11 mRNA in gastric carcinoma tissues was significantly higher than that of the adjacent tissues ( t=11.38, P<0.05). Its expression was related to tumor size, depth of invasion, lymph node metastasis and TNM clinical stage (all P<0.05). The proliferation of BGC823 cells was significantly suppressed after KLF11 silencing ( F=19.56, P<0.05), and the cell cycle was arrested in G 0/G 1 phase [(41.40%±0.98%) vs. (66.53%±1.01%), F=32.69, P<0.05]. Meanwhile, the apoptosis rate was significantly increased by KFL11 silencing [(41.44%±1.59%) vs. (15.42%±0.86%), F=35.35, P<0.05]. The results of Western blotting revealed that the expression of Bax and Cleaved Caspase3 was significantly increased ( F=23.33, 33.63; both P<0.05), wheras that of β-catenin, Bcl-2, CyclinD1and CyclinE was significantly reduced ( F=22.21, 16.24, 26.75, 33.42; all P<0.05). The activity of Caspase3 enzyme was enhanced ( F=16.56, P<0.05). Conclusion:KLF11 was highly-expressed in gastric cancer tissues and cells, KFL11 silencing could inhibit gastric cancer cells proliferation and induce cell apoptosis via Wnt/β-catenin signaling pathway.

Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision: A single-center experience of 13 patients / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility, safety, and short-term effect of minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision. Methods    The clinical data of 13 patients who underwent minimally invasive ascending aorta surgery (including minimally invasive Bentall operation in 7 patients, minimally invasive Wheat operation in 2 patients, and minimally invasive ascending aorta replacement in 4 patients) through a right anterior thoracotomy via the second intercostal incision in our center from October, 2019 to September, 2020 were retrospectively analyzed. There were 12 males and 1 female at age of 19-69 (52.4±13.7) years. Results    The aortic cross-clamping time was 84.3±18.3 min. Three patients received blood transfusion, with the rate of 23.1%. The drainage volume in the first 24 hours after operation was 214.5±146.3 mL, with no redo for bleeding. The duration of mechanical ventilation was 19.0±11.3 hours and the length of intensive care unit stay was 1.8±1.3 days. The drainage tube was removed 2.5±1.0 days after operation. All the 13 patients recovered and discharged 6.4±2.0 days after operation, with no dead patients found. All patients survived with New York Heart Association (NYHA) functional classⅠandⅡduring a median follow-up of 8 months. Conclusion    Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision may be a safe and effective method with less injury and quick recovery.

Advances in the prediction of the efficacy and sensitivity of neoadjuvant chemoradiotherapy in rectal cancer / 中华胃肠外科杂志

Rectal cancer has become one of the most common malignant tumors in our country. The treatment of total mesorectal excision after neoadjuvant chemoradiotherapy (NCRT) has become a standard treatment mode for locally advanced rectal cancer. However, the response of patients with rectal cancer to neoadjuvant chemotherapy varies, and treating all patients with NCRT may be suboptimal. Accurately predicting the efficacy and sensitivity of NCRT can help adjust treatment plan timely and avoid delay of condition in patients who are insensitive to NCRT. Existing research has confirmed that TNM staging, tumor regression grade and tumor markers and other clinical indicators can effectively predict the efficacy and sensitivity of NCRT, all kinds of clinical guidelines also recommend the three as a routine examination of patients with rectal cancer during NCRT. However, with the proposal of the concept of "Precise Medicine", the above clinical indexes cannot meet the clinical need of accurate treatment of rectal cancer. In recent years, with the accumulating studies on tumor immunotherapy, researchers have found that the sensitivity of NCRT is not only related to tumor biological characteristics, but also closely related to tumor microenvironment. Based on the current research, the indicators of tumor microenvironment, such as lymphocyte subsets count, neutrophil-lymphocyte ratio and programmed cell death ligand 1, have great potential clinical value in predicting the efficacy and sensitivity of rectal cancer. Further research based on relevant indicators of tumor microenvironment will enable accurate prediction of NCRT efficacy and sensitivity of NCRT and has important clinical significance for the realization of accurate and individualized treatment of rectal cancer.

Myocardial revascularization among patients with severe left ventricular dysfunction: a comparison between on-pump beating-heart and off-pump coronary artery bypass grafting / 中华外科杂志

Objective@#To evaluate the impacts of an on-pump beating-heart versus an off-pump coronary artery bypass grafting (CABG) technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (EF) of 35% or less.@*Methods@#A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study and were divided into either an OBCAB group (patients who received on-pump beating-heart CABG surgery, n=88) or an OPCAB group (patients who received off-pump CABG surgery, n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t-test, χ2 test or Fisher′s exact test, when appropriate.@*Results@#No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo-diastolic diameter in the OBCAB group. Patients in the OBCAB group compared to the OPCAB group had a similar in-hospital mortality (3.4% vs. 4.7%, P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge), significantly improved from (31.0±2.8)% to (35.6±2.9)% (t=10.61, P=0.000) in the OBCAB group and from (31.0±2.9)% to (34.8±3.3)% (t=9.68, P=0.000) in the OPCAB group, respectively. The improvement of mean LVEF in the OBCAB group was significantly higher than that in the OPCAB group ((4.7±0.2)% vs. (3.6±0.3)%, t=29.53, P=0.000). Patients in the OBCAB group compared to the OPCAB group had a significant higher early postoperative EF ((35.6±2.9)% vs.(34.8±3.3)%, t=1.892, P=0.034) but shared a similar baseline EF ((31.0±2.8)% vs. (31.0±2.9)%, t=0.012, P=0.930). Patients in the OBCAB group compared to the OPCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7±0.8 vs. 2.8±0.6, t=9.442, P=0.000; (715±187) ml vs. (520±148) ml, t=8.544, P=0.000, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity.@*Conclusion@#The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated EF of 35% or less.

Long-term Prognosis of Revascularization in Patients With Ostial/shaft Lesions of Unprotected Left Main Coronary Artery (ULMCA) / 中国循环杂志

Objective:To compare the long-term prognosis of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with ostial/shaft lesions of unprotected left main coronary artery (ULMCA).Methods:A total of 259 patients with isolated ostial/midshaft lesions of ULMCA who received PCI or CABG in our hospital from 2003-01 to 2009-07 were enrolled.The patients were divided into 2 groups:PCI group,n=149 patients who received drug-eluting stents (DES) implantation and CABG group,n=110.The end points were all cause death,myocardial infarction (MI) and major adverse cardiac and cerebrovascular events (MACCE) which included cardiac death,non-fetal MI,stroke,repeated revascularization and the composite events death.Results:The median follow-up period was 7.1 years (inter quartile range 5.3-8.2 years) in all patients.Before multivariate adjusting,the following parameters were similar between PCI group and CABG group:all cause death (12.7％ vs 29.7％),P=-0.096;non-fatal MI (14.8％ vs 8.5％),P=0.844;stroke (9.3％ vs 6.3％),P=0.904;repeated revascularization (26.8％ vs 19.0％),P=0.234;composite events of cardiac death/stroke/MI (18.9％ vs 20.3％),P=0.224 and MACCE occurrence (37.5％ vs 34.2％),P=0.946.With adjusted variations,the trend was similar to pre-adjustment.Conclusion:During the maximum 8.2 years follow-up period,PCI and CABG had the similar efficacy and safety in patients with ostial/shaft lesions of ULMCA.

Research on the Effect of Information Intelligence Technology in Hospital Operation Decision / 中国卫生经济

Objective:To observe and analyze the effects of information intelligence technology in hospital operation decision.Methods:Relevant factors have been analyzed vertically before and after the application of information intelligence technology in Beijing Cancer Hospital.In this case,data should be analyzed before and after the usage of the information intelligence technology,in terms of medical quality (bed usage,average length of hospitalization,the number of cases,etc.),workloads (number of visits,number of discharged patients,etc.),social benefits (patient satisfaction and employee satisfaction),and economic benefits (total assets,net assets,fixed assets,business income,per capita business income,etc.).Results:Mter the implementation of information intelligence technology,bed occupancy rate and the number of discharged was higher than that before implementation,as well as average length of hospitalization was significantly lower than before.Secondly,the number of visits,discharged persons,total assets,net assets,business income and per capita business income and the satisfaction rate of patients and staff after the implementation of the information intelligence technology were significantly higher than those before.Conclusion:Information intelligence technology could improve medical process and service efficiency,as well as reduce medical disputes and doctor-patient contradiction in hospital operation decision-making.Moreover,the satisfaction of doctors and patients could be ameliorated,manpower and material resources could be saved significantly as well,and the management efficiency would be effectively improved.

Long-term Prognosis of Revascularization in Patients With Ostial/shaft Lesions of Unprotected Left Main Coronary Artery (ULMCA) / 中国循环杂志

Objective:To compare the long-term prognosis of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with ostial/shaft lesions of unprotected left main coronary artery (ULMCA).Methods:A total of 259 patients with isolated ostial/midshaft lesions of ULMCA who received PCI or CABG in our hospital from 2003-01 to 2009-07 were enrolled.The patients were divided into 2 groups:PCI group,n=149 patients who received drug-eluting stents (DES) implantation and CABG group,n=110.The end points were all cause death,myocardial infarction (MI) and major adverse cardiac and cerebrovascular events (MACCE) which included cardiac death,non-fetal MI,stroke,repeated revascularization and the composite events death.Results:The median follow-up period was 7.1 years (inter quartile range 5.3-8.2 years) in all patients.Before multivariate adjusting,the following parameters were similar between PCI group and CABG group:all cause death (12.7％ vs 29.7％),P=-0.096;non-fatal MI (14.8％ vs 8.5％),P=0.844;stroke (9.3％ vs 6.3％),P=0.904;repeated revascularization (26.8％ vs 19.0％),P=0.234;composite events of cardiac death/stroke/MI (18.9％ vs 20.3％),P=0.224 and MACCE occurrence (37.5％ vs 34.2％),P=0.946.With adjusted variations,the trend was similar to pre-adjustment.Conclusion:During the maximum 8.2 years follow-up period,PCI and CABG had the similar efficacy and safety in patients with ostial/shaft lesions of ULMCA.

Changes of lymphocyte subsets and their signiifcance in children with hemophagocytic lymphohistiocytosis / 临床儿科杂志

ObjectiveTo explore the role of the lymphocyte subsets in the peripheral blood in diagnosis, treatment and prognosis of hemophagocytic lymphohistiocytosis (HLH) in children.MethodA total of 30 children with HLH were enrolled in this study and treated according to the HLH-2004 diagnostic guidelines. 20 children with HLH entered complete remission (CR) and 10 children with HLH died. Thirty age-matched healthy children were selected as normal controls. T cell subsets in the pe-ripheral blood were measured by lfow cytometry.ResultsCompared with control group, CD3+T and CD8+T cells were signiif-cantly increased, CD4+T and CD3-CDl6+CD56+ NK cells were signiifcantly decreased, and CD4+/CD8+ cell ratio was signiifcantly decreased in 20 CR children and 10 died children with HLH in acute phase (P0.05). In acute phase, the lymphocyte subsets were not statistically different between 20 CR children and 10 died children (P>0.05). In 20 CR children, the proportion of CD3-CD16+CD56+NK in CR phase was statistically different than that in acute phase (P<0.05).ConclusionsChildren with HLH have obvious changes in peripheral blood lymphocyte subsets and have cellular immunity disorders. Dynamic detection of the changes may help determine the therapeutic effect and prognosis of HLH.

Relationship between α-fetoprotein polymorphisms and peripheral α-fetoprotein level in hepatocellular carcinoma patients / 第二军医大学学报

Objective: To study the relationship between α-fetoprotein (AFP) polymorphisms and peripheral AFP level in hepatocellular carcinoma (HCC) patients. Methods: Using polymerase chain reaction-ligation detection reaction (PCR-LDR) technique, we determined the polymorphisms of AFP of 335 HCC patients; the serum levels of AFP were also determined. SPSS 13. 0 softwarewas used for statistical analysis. Results: The GG genotype frequency of -205 OG of AFP gene was significantly different between patients with AFP values: ≥20 and T, intron7 A>G, 3′UTR A>G and intron2 A>G, in AFP gene. Conclusion: In HCC patients among Chinese Hnn population, the C allele and CC genotype of -205 C>G polymorphism site in AFP gene is associated with higher AFP values.

Clinical outcomes of modified 360° fusion for lumbar spondylolisthesis / 中华骨科杂志

Objective To analyze the clinical results of 360° fusion for spondylolisthesis.Methods Data of 76 patients from March 2005 to November 2012,including 26 males and 50 females with a mean age of 54.3 years were retrospectively analyzed.All patients had undergone modified 360° fusion.The clinical outcomes were evaluated by the Japanese Orthopaedic Association scores (JOA) and visual analogue scale (VAS).The fusion status and loss of correction were assessed by CT and plain radiographs.Results All patients had been successfully followed up for at least one year.Post-operative reduction rate was 96.8％,with a mean loss rate of 1.1％ at six months and 0.8％ at one year follow-up separately,but the difference was not significant.Postoperative percentage of slip,lumbar lordosis,intervertebral disc height and slip angle had significant differences,compared with those of the pre-operative,but the difference between one week post-operative,six months follow-up and one year follow-up were not significant.The fusion rate was 76.3％ at six months follow-up and 98.7％ at one year follow-up,and there were significant differences.Both JOA and VAS score at six months and one year follow-up indicated significant differences in contrast to that of preoperative.Dural injury was found in one patient,and subsidence was found in one patient.One received a second operation at 3 months after the surgery due to screw loose.Conclusions Modified 360° fusion shows great clinical outcome and fusion rate,which can be a dominant procedure for treating spondylolisthesis.

Regulation effect of adipose-derived mesenchymal stem cells on pancreatic cancer cells / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the effects of adipose tissue-derived stem cells (ADSCs) on the proliferation and invasion of pancreatic cancer (PaCa) cells and the the possible mechanism involved.</p><p><b>METHODS</b>ADSCs were isolated and co-cultured with PaCa cells. CCK-8 assay was used to detect the proliferation of PaCa cells. An ELISA was used to determine the concentration of stromal cell-derived factor-1 (SDF-1) in the supernatants. The proliferation of PaCa cells by SDF-1 was measured. AMD3100 regulated the co-culture of ADSCs and PaCa. The tumor growth of PaCa cells was assessed after treatment by ADSCs in vivo.</p><p><b>RESULTS</b>ADSCs can promote the proliferation and invasion of PaCa cells (proliferation: SW1990: 1.535 ± 0.153; PANC-1: 1.370 ± 0.100; the value of control was 1; invasion: SW1990: 47.0 ± 2.6 vs. 28.3 ± 1.3; PANC-1: 40.3 ± 1.8 vs. 24.3 ± 1.3; t = 4.332-9.558, P < 0.05). The expression of SDF-1 was high in ADSCs, but not in PaCa cells (69 ± 5 vs. 0 and 0, F = 389.134, P < 0.01). The promotion of SDF-1 on PaCa cells depends on the concentration. AMD3100 significantly downregulates these growth-promoting effects of ADSCs on PaCa cells. ADSCs significantly promoted the growth of SW1990 in nude mice at the 5(th) week (volume: (1295 ± 102) mm(3) vs. (967 ± 81) mm(3), t = 5.614, P < 0.05) , but not in PANC-1 cell.</p><p><b>CONCLUSION</b>ADSCs can promote the proliferation and invasion of PaCa cells, which may involve the SDF-1/CXCR4 axis.</p>

Changes of erythrocyte rheology in rabbits with acute renal failure / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To observe the change of erythrocyte theology in rabbits with acute renal failure (ARF).</p><p><b>METHODS</b>Thirty-eight healthy rabbits were randomly divided into control group (n = 8), model group (establishing ARF model via intramuscular injection 1% HgCl2, and divided into 12 h, 24 h, 48 h subgroups, all n = 10), the arterial blood sample was taken out through carotid artery at corresponding times after anesthetization with urethane, for detecting the indices of renal function and erythrocyte rheology.</p><p><b>RESULTS</b>The levels of urea and creatinine in plasma of model rabbits at 12 h, 24 h and 48 h were higher than those of control group, and there was a rise trend along with the time extension. The erythrocytes electrophoresis time at 12 h of model group was higher, the electrophoresis rate and migration rate of erythrocytes were lower compared with those of control group; the erythrocytes electrophoresis time at 24 h of model group was lower and the electrophoresis rate and migration rate were higher compared with those of model group at 12 h; and there were no statistical differences in erythrocytes electrophoresis indices between model group at 48 h and other groups. Meanwhile, there was a rise trend in erythrocyte sedimentation rate (ESR), K value of equation and emendation along with the time extension of ARF, but these indices only at 48 h of model group was lower significantly than that of control group. There were no statistical differences in aggregation index and deformability index of erythrocytes among groups.</p><p><b>CONCLUSION</b>During the process of ARF, the erythrocytes electrophoresis time lengthen and electrophoresis rate and migration rate decrease at early stage, and these indices gradually return to normal; the indices of ESR increase gradually.</p>

Clinical significance of dynamic monitoring the minimal residual disease in childhood B-lineage acute lymphoblastic leukemia by multiparameter flow cytometry / 中国实验血液学杂志

This study was aimed to explore the clinical significance of monitoring level of minimal residual disease (MRD) at different time point in B-lineage childhood acute lymphoblastic leukemia (B-ALL). Two hundred and six children with B-ALL were enrolled in this study from Augest 2008 to September 2011 in our hospital. MRD levels were detected by flow cytometry at day 15, 33 and week 12 after initial chemotherapy. The event-free survival (EFS) for patients based on MRD levels measured at different stages of chemotherapy were compared by Kaplan Meier analyses. The results showed that out of 206 cases 196 cases achieved complete remission (CR) after induction therapy (CR rate 95.1%), the 1- and 3-year EFS rate were (92.7 ± 1.8)% and (78.7 ± 3.7)%, respectively, and the 3-year EFS rate was (85.6 ± 4.9)% in standard risk group, (82.1 ± 5.8)% in intermediate risk group and (58.1 ± 9.2)% in high risk group, there was significant statistical difference between above mentioned 3 groups (P < 0.001). The MRD analysis at different time points showed that the higher the MRD level, the lower the 3-year EFS rate of children with ALL, in which the 3-year EFS rate of MRD ≥ 10(-2) at day 15, MRD ≥ 10(-3) at day 33 and MRD ≥ 10(-3) at week 12 were significantly lower. The MRD ≥ 10(-3) at week 12 was proven to be an independent predictor by multivariate Cox proportional-hazards regression model. The 3-year EFS rate for patients with MRD < 10(-3) and MRD ≥ 10(-3) at week 12 were (86.3 ± 4.1)% vs (55.8 ± 9.1)% (P < 0.05); 8 relapsed among 98 cases with negative MRD (MRD < 10(-4)) at day 33, 19 relapsed among 108 cases with positive MRD at day 33 between the two groups for recurrence rate has significant difference (P < 0.05). It is concluded that dynamically monitoring MRD by multi-parameter flow cytometry can precisely evaluate treatment response, judge treatment outcome and predict relapse in childhood B-ALL. The MRD 10(-2) at day 15, MRD 10(-3) at day 33 and MRD 10(-3) at week 12 should be considered as the best cut-off. MRD ≥ 10(-3) at week 12 was proven to be an independent factor of poor prognosis.

Progress on DNA quantification in estimation of postmortem interval / 法医学杂志

Estimation of postmortem interval (PMI) is one of the difficult problems in forensic medicine. With the development of molecular biological techniques, DNA quantification methods were widely applied in estimating PMI. The postmortem degradation of DNA in different tissues and organs was discussed in this article and the recent DNA quantitative techniques being used for estimating PMI were reviewed. These techniques included single cell gel electrophoresis, Feulgen staining image analysis, flow cytometry.