In vivo and in vitro inductively coupled plasma mass spectrometry quantification of minerals and heavy metals in Qishiwei Zhenzhu pill and their effect on intestinal flora / 中国药理学与毒理学杂志

OBJECTIVE Cerebral ischemia or ischemic stroke is due to insufficient blood supply to the brain, which causes hypoxia or ischemia in some areas. This work aimed to quantify the minerals and heavy metals in Qishiwei Zhenzhu pill in vivo and in vitro, analyze its effect on the types and abundance of intestinal flora, and study its mechanism on inflammation and apoptosis pathways as a treatment for cerebral ischemia. METHODS Microwave digestion and induc?tively coupled plasma mass spectrometry (ICP-MS) were used to determine the minerals and heavy metals in 10 batches of Qishiwei Zhenzhu pill in vitro. With the use of the middle cerebral artery obstruction (MCAO) model, ICP-MS was applied to determine the content of minerals and heavy metals in hepatic portal vein blood, abdominal aortic blood, brain, liver, kidney, hair, urine and feces at different time periods. On this model, the ileum, cecum, and colon tissues were tested for intestinal pathology, and 16S rRNA was used for sequencing. Species taxonomy, α diversity, and spe?cies microbial composition and structure analysis were also performed. Polymerase chain reaction and Western blotting were employed to determine the mRNA and protein expression of p38 MAPK, caspase-3, IL-1β and TNF-α in the isch?emic brain tissues of rats. RESULTS The average content of heavy metals in the 10 batches of Qishiwei Zhenzhu pill samples is in the descending order Hg>Cu>Pb. Significant differences in the metal elements are found among Qishiwei Zhenzhu pill from different manufacturers but not among the different batches of the same manufacturer. An extremely low content of heavy metals are absorbed into the blood or accumulated in the brain, liver, kidney, and other tissues. Stool is the main excretion route of minerals and heavy metals from Qishiwei Zhenzhu pill. This medicine helps repair the intestinal mucosa in MCAO rats. At the phylum level, it can regulate the abundance of Firmicutes and Proteobacteria in the intestinal flora of rats with cerebral ischemia. At the genus level, it can adjust the abundance of Escherichia Shigella. At the species level, it can adjust the abundance of Lactobacillus yoelii and Lactobacillus reuteri. Cluster classification results show that Qishiwei Zhenzhu pill can improve the intestinal flora of rats with cerebral ischemia, reduce the mRNA and protein expression of caspase-3 and IL-1βin rat brain tissues, and have a tendency to decrease the mRNA expres?sion of p38 MAPK and TNF-α. CONCLUSION Quantifying the minerals and heavy metals in Qishiwei Zhenzhu pill in vivo and in vitro will help improve their quality standards. Minerals and heavy metals are mainly excreted in feces, accumu?late in extremely low levels in various tissues, and do not damage the intestinal mucosa. The effective material basis of Qishiwei Zhenzhu pill in treating cerebral ischemia may be related to their Li, Cr, and Cd elements. These pills can improve the environment of intestinal flora, and their mechanism of treatment for cerebral ischemia may be related to the down-regulation of IL-1βinflammatory factor and inhibition of cell apoptosis.

Clinical outcomes of microdissection testicular sperm extraction-intracytoplasmic sperm injection with fresh or cryopreserved sperm in patients with nonobstructive azoospermia / 亚洲男科学杂志(英文版)

We performed this study to evaluate the clinical outcomes of microdissection testicular sperm extraction-intracytoplasmic sperm injection (micro-TESE-ICSI) treatment that used fresh or cryopreserved sperm in patients with nonobstructive azoospermia (NOA). A total of 338 NOA patients with 344 consecutive cycles received treatment in the reproductive medicine center of Peking University Third Hospital in Beijing, China, from January 2014 to December 2017. Fresh oocytes and fresh sperm were used in 222 patients with 234 cycles (Group A). Fresh oocytes and cryopreserved sperm were used in 116 patients with 110 cycles (Group B). We compared patient characteristics, embryonic development, and pregnancy outcomes between Groups A and B. There was no statistical difference in the patient characteristics, and no differences were observed with fertilization or quality embryo rates between Groups A and B. The rates of clinical pregnancy and live birth were both higher for Group A than those for Group B (both P < 0.05). In conclusion, fresh testicular sperm appears to produce better ICSI outcomes than cryopreserved testicular sperm in patients with NOA.

Sperm retrieval rates and clinical outcomes for patients with different causes of azoospermia who undergo microdissection testicular sperm extraction-intracytoplasmic sperm injection / 亚洲男科学杂志(英文版)

The aim of our study was to compare the sperm retrieval rates (SRRs) and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sperm injection (micro-TESE-ICSI). We conducted a retrospective study at the Reproductive Medicine Center of Peking University Third Hospital in Beijing, China, from January 2014 to December 2017. This study examined 769 patients with nonobstructive azoospermia who underwent 347 cycles of micro-TESE-ICSI. Patients with azoospermia were classified into Group A (Klinefelter syndrome, n = 284, 125 cycles), Group B (azoospermia Y chromosome factor c [AZFc] microdeletion, n = 91, 64 cycles), Group C (cryptorchidism, n = 52, 39 cycles), Group D (previous mumps and bilateral orchitis, n = 23, 23 cycles), and Group E (idiopathic azoospermia, n = 319, 96 cycles). Clinical characteristics, SRR, embryonic development, and pregnancy outcomes of the patients were compared between all groups. Patients in Group D had the highest and most successful SRR. The average SRR for all patients was 46.0%. The rates of clinical pregnancy, implantation, and live birth in Group D were 78.3%, 65.0%, and 74.0%, respectively, which were higher than those in all other groups (P 0.05). Patients with orchitis had the highest SRR and best clinical outcomes. Although AZFc microdeletion patients had a higher SRR, their clinical outcomes were worse.

The influencing factors of long-term care insurance demand in China: An empirical study based on Jiangsu Province / 中国卫生政策研究

Objective: To explore the influencing factors of the long-term care insurance demand in Jiangsu province and provide reference for the establishment and improvement of a perfect long-term care insurance system in China. Methods:Factor analysis,multiple regression analysis and logistic regression analysis were applied for analy-zing the survey data collected from Jiangsu province. Results: (1) From the perspective of subjective attitude fac-tors,nursing expenses,family ability to pay,insurance concepts, nursing needs and chronic disease awareness and long-term care insurance demand are positively correlated,and the impact was significant;(2) From the perspective of demographic factors, residents with a high level of education are more willing to buy long-term care insurance. Conclusions: The Chinese government should take full account of the influencing factors of long-term care insurance demand,improve the income of urban and rural residents,increase promotional activities,and encourage nursing in-stitutions to develop at different levels,and build a government-led long-term care service system.

Targeted elimination of mutant mitochondrial DNA in MELAS-iPSCs by mitoTALENs

Mitochondrial diseases are maternally inherited heterogeneous disorders that are primarily caused by mitochondrial DNA (mtDNA) mutations. Depending on the ratio of mutant to wild-type mtDNA, known as heteroplasmy, mitochondrial defects can result in a wide spectrum of clinical manifestations. Mitochondria-targeted endonucleases provide an alternative avenue for treating mitochondrial disorders via targeted destruction of the mutant mtDNA and induction of heteroplasmic shifting. Here, we generated mitochondrial disease patient-specific induced pluripotent stem cells (MiPSCs) that harbored a high proportion of m.3243A>G mtDNA mutations and caused mitochondrial encephalomyopathy and stroke-like episodes (MELAS). We engineered mitochondrial-targeted transcription activator-like effector nucleases (mitoTALENs) and successfully eliminated the m.3243A>G mutation in MiPSCs. Off-target mutagenesis was not detected in the targeted MiPSC clones. Utilizing a dual fluorescence iPSC reporter cell line expressing a 3243G mutant mtDNA sequence in the nuclear genome, mitoTALENs displayed a significantly limited ability to target the nuclear genome compared with nuclear-localized TALENs. Moreover, genetically rescued MiPSCs displayed normal mitochondrial respiration and energy production. Moreover, neuronal progenitor cells differentiated from the rescued MiPSCs also demonstrated normal metabolic profiles. Furthermore, we successfully achieved reduction in the human m.3243A>G mtDNA mutation in porcine oocytes via injection of mitoTALEN mRNA. Our study shows the great potential for using mitoTALENs for specific targeting of mutant mtDNA both in iPSCs and mammalian oocytes, which not only provides a new avenue for studying mitochondrial biology and disease but also suggests a potential therapeutic approach for the treatment of mitochondrial disease, as well as the prevention of germline transmission of mutant mtDNA.

Sperm origins and concentration do not impact the clinical outcomes in intracytoplasmic sperm injection cycles / 亚洲男科学杂志(英文版)

In the present study, we evaluated the impact of sperm origins and concentration on the clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles. A total of 1201 ICSI cycles were retrospectively analyzed for male azoospermia or oligozoospermia between January 2015 and December 2015 in the Peking University Third Hospital. Patients were divided into three groups (Group 1 vs Group 2/3; surgically extracted sperm vs ejaculated sperms): Group 1 included 343 ICSI cycles and Group 2 analyzed 388 cycles on semen with sperm concentration <5 × 106 ml-1 (severe oligozoospermia group). Group 3 included 470 cycles with sperm concentration between 5 × 106 ml-1 and 15 × 106 ml-1 (mild oligozoospermia group). Fertilization rates, clinical pregnancy rates, and live birth rates were analyzed and compared among groups of different semen origins and concentrations on the oocyte retrieval day. Group 2 showed a lower fertilization rate than Group 3 (62.9% ± 21.6% vs 66.8% ± 22.1%,P< 0.05). There were no statistically significant differences in clinical pregnancy rate per transfer (51.3%, 46.7%, and 50.0%, respectively), live birth rate per transfer (44.4%, 40.9%, and 41.4%, respectively), accumulative live birth rate (58.3%, 51.0%, and 52.1%, respectively), twin birth rate (18.4%, 10.6%, and 12.6%, respectively), and birth defects rate (0, 0.3%, and 0.2%, respectively) among three groups. The results of this study indicated that sperm origins and concentration do not impact the clinical outcomes in ICSI cycles.

Effects of delayed umbilical cord clamping on maternal and neonatal outcomes / 中华护理杂志

Objective To determine the effects of delayed umbilical cord clamping on the postpartum hemorrhage,instant and long-term newborn anemia,newborn jaundice.Methods In total,303 infants were selected during October 2016 to June 2017 in three hospitals in Beijing.They were randomly allocated into two groups receiving instant clamping of umbilical cord (less than 60s after delivery,n=158) and delayed clamping of umbilical cord(after cord pulsation ceased,n=145).Relevant indicators of maternal and neonatal outcomes are compared.Results There were significant differences between two groups in instant hemoglobin concentration and in 5～7 days (P＜0.05).There were no differences between two groups in transcutaneous bilirubin,the risk of anemia in three months,the risk of jaundice in 5～7 days and the need of blue-light therapy (P＞0.05).There were no differences between two groups of women in postpartum hemorrhage,the length of third stage of labor and the rate of breast feeding (P＞0.05).Conclusion Clamping the umbilical cord when cord pulsation has ceased does not have negative effects on delivery process and postpartum hemorrhage,but it increases the instant hemoglobin concentration and hemoglobin concentration after delivery in 5～7 days.Still it is unclear whether it will affect the risk of jaundice.

Association between metabolic syndrome and colorectal carcinoma based on a case-control study / 国际肿瘤学杂志

Objective To evaluate the association between metabolic syndrome and colorectal carcino-ma. Methods A total of 900 patients with colorectal carcinoma from 2013 to 2016 in Qianfoshan Hospital Af-filiated to Shandong University were selected as the case group and 1774 non-colorectal carcinoma participants from health management center as the control group. Logistic regression model was used to identify the relation-ship between metabolic syndrome and colorectal carcinoma. Results Compared with the controls (27. 0％), metabolic syndrome was more prevalent among cases (35. 4％). The difference was statistically significant (χ2 = 20. 33,P < 0. 01). Multivariate logistic regression analyses showed that metabolic syndrome as an entity increased colorectal carcinoma risk (OR = 1. 38,95％ CI:1. 08-1. 75,χ2 = 17. 68,P < 0. 01). Subjects with 2 and 3 or more components of the metabolic syndrome had an increased risk of colorectal carcinoma,and the ORs of colorectal carcinoma were 1. 37 and 1. 60,respectively. Gender-specific patterns were also observed in the association between metabolic syndrome,component and colorectal carcinoma (χ2 = 5. 40,P = 0. 02;χ2 =8. 66,P < 0. 01). Conclusion Metabolic syndrome is associated with the occurrence of colorectal carcinoma. An increasing trend in risk of colorectal carcinoma with the number of metabolic syndrome components is observed.

Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Increased salivary pepsin could indicate an increase in gastro-esophageal reflux, however, previous studies failed to demonstrate a correlation between salivary pepsin concentrations and 24-hour esophageal acid exposure. This study aims to detect the salivary pepsin and to evaluate the relationship between salivary pepsin concentrations and intercellular spaces (IS) in different gastroesophageal reflux disease phenotypes in patients. METHODS: A total of 45 patients and 11 healthy volunteers were included in this study. All subjects underwent upper gastrointestinal endoscopy, 24-hour ambulatory multichannel impedance-pH (MII-pH) monitoring, and salivary sampling at 3-time points during the 24-hour MII-pH monitoring. IS were measured by transmission electron microscopy, and salivary pepsin concentrations were determined by enzyme-linked immunosorbent assay. RESULTS: The IS measurements were greater in the esophagitis (EE), non-erosive reflux disease (NERD), and hypersensitive esophagus (HO) groups than in the functional heartburn (FH) and healthy volunteer groups, and significant differences were indicated. Patients with NERD and HO had higher average pepsin concentrations compared with FH patients. A weak correlation was determined between IS and salivary pepsin among patients with NERD (r = 0.669, P = 0.035). CONCLUSIONS: We confirmed the presence of a higher level of salivary pepsin in patients with NERD than in patients with FH. Salivary pepsin concentrations correlated with severity of mucosal integrity impairment in the NERD group. We suggest that in patients with NERD, low levels of salivary pepsin can help identify patients with FH, in addition the higher the pepsin concentration, the more likely the severity of dilated IS.

Microdissection testicular sperm extraction for patients with nonmosaic Klinefelter syndrome: A report of 143 cases / 中华男科学杂志

Objective@#To investigate the clinical application and outcomes of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS).@*METHODS@#A total of 143 nonmosaic KS patients underwent micro-TESE in the Center of Reproductive Medicine of Peking University Third Hospital between July 2012 and August 2016. We analyzed their clinical and follow-up data and evaluated the outcomes.@*RESULTS@#Spermatozoa were successfully retrieved from the testicular tissue in 44.76% (64/143) of the patients, 84.4% (54/64) by unilateral and 15.6% (10/64) by bilateral micro-TESE. Seventy-five of the KS patients were followed up in the years of 2014 and 2015. Of the 34 patients with successful sperm retrieval, 73.52% (25/34) achieved clinical pregnancy and 8 boys and 8 girls were already born in 14 of the 25 cases.@*CONCLUSIONS@#The micro-TESE is a useful method for sperm retrieval in nonmosaic KS patients, with high rates of sperm retrieval, clinical pregnancy, and birth of biological offspring.

Development and application of intraoperative specimen collector for urinary endoscopy / 中华护理杂志

Objective To solve the problems of flushing fluid overflow pollution in urinary endoscopy surgery and specimen run-off in flushing fluid.Methods An intraoperative specimen collector was designed and developed.Totally 212 patients were enrolled and divided into the experimental group (n=106) and the control group (n=106).Effects of application were evaluated by comparing contamination rate due to flushing fluid leakage,degree of patient comfort and degree of nursing satisfaction.Results Contamination rate due to flushing fluid leakage in the experimental group was significantly lower than that in the control group(P＜0.05).Degree of patient comfort and degree of nursing satisfaction in the experimental group were significantly better than those in the control group (P＜0.05).Conclusion The application of intraoperative specimen collector in urinary endoscopy surgery can effectively reduce pollution of staff and environment in operating room,improve retention rate of surgical specimen,increase patient comfort and satisfaction,and guarantee the success of the surgery.

Development and application of intraoperative specimen collector for urinary endoscopy / 中华护理杂志

Objective To solve the problems of flushing fluid overflow pollution in urinary endoscopy surgery and specimen run-off in flushing fluid.Methods An intraoperative specimen collector was designed and developed.Totally 212 patients were enrolled and divided into the experimental group (n=106) and the control group (n=106).Effects of application were evaluated by comparing contamination rate due to flushing fluid leakage,degree of patient comfort and degree of nursing satisfaction.Results Contamination rate due to flushing fluid leakage in the experimental group was significantly lower than that in the control group(P＜0.05).Degree of patient comfort and degree of nursing satisfaction in the experimental group were significantly better than those in the control group (P＜0.05).Conclusion The application of intraoperative specimen collector in urinary endoscopy surgery can effectively reduce pollution of staff and environment in operating room,improve retention rate of surgical specimen,increase patient comfort and satisfaction,and guarantee the success of the surgery.

Mild-warm moxibustion for prevention of PICC-related upper extremity deep vein thrombosis in gastrointestinal cancer patients / 中华护理杂志

Objective To explore the effects of mild-warm moxibustion on PICC-related upper extremity deep vein thrombosis in gastrointestinal cancer patients.Methods Totally 117 patients with PICC were randomly assigned into the experimental group and the control group.All patients received routine PICC care,the control group was given normal saline for sealing tubes,the experimental group was given mild-warm moxibustion and normal saline.Incidence of thrombosis and indicators of hemorheology were compared between two groups.Results For incidence of thrombosis:7 days after placement,incidence of thrombosis in the experimental group was significantly lower than that in the control group(P＜0.05).For indicators of hemorheology:the whole blood viscosity at low shear and high shear,erythrocyte aggregation index,whole blood viscosity,and hematocrit were significantly lower in the experimental group than the control group.Conclusion Mild-warm moxibustion can effectively prevent thrombotic formation in gastrointestinal cancer patients with PICC by influencing hemorheology.

Clinical features of brucellosis complicated with osteoarticular damage / 中华地方病学杂志

Objective To evaluate the clinical features of osteoarticular damage of patients with brucellosis,and to enhance the knowledge of clinical doctors.Methods The demographic characteristics,clinical presentations,accessory examination of 265 patients with brucellosis admitted from January 2011 to April 2014 in Ji'nan Infectious Diseases Hospital were retrospectively analyzed.Patients were classified into two groups:Patients with osteoarticular complications and patients without osteoarticular complications.Results Of the 265 patients,forty-six patients (17.36％) had osteoarticular complications.Spondylitis was the most common complication [50.00％ (23/46)],followed by sacroiliitis [41.30％ (19/46)] and peripheral arthritis [26.09％ (12/46)].Sacroiliitis was more common than other types of osteoarticular damage in females [21.74％ (10/46)],whereas in males spondylitis was more common [36.96％ (17/46)].Peripheral arthritis was more common in individuals under the age of 17 years old [4.35％ (2/46)],and sacroiliitis were more common in the ages of 18-60 years old group [23.91％(11/46)] and spondylitis were more common in over 60-year age group [30.43％ (14/46)].Patients with osteoarticular complications showed longer duration of illness from the onset of the symptoms to its diagnosis (median 45 days),compared to those non-osteoarticular brucellosis (median 30 days,Z =5.74,P ＜ 0.05).Conclusion Due to diversity of osteoarticular damage in patients with brucellosis,in case of a patient with long-term fever and osteoarticular symptoms,medical and epidemiological history should be inquired so as to strengthen early diagnosis and treatment of the disease based on combination with radiological findings.

Advances in cell proliferation and apoptosis signal pathway and therapies of polycystic kidney disease / 解放军医学杂志

Polycystic kidney disease (PKD) is one of the monogenic inherited diseases. In PKD, excessive cell proliferation and fluid secretion, and disruption of the mechanisms controlling tubular diameter may all lead to cyst formation. Current evidence has demonstrated that intracellular calcium ion and cAMP imbalance drive both abnormal cell proliferation and apoptosis signal pathway. The present paper summarized the evidence implicating calcium ion and cAMP as central players in the signaling pathway of cell proliferation and apoptosis in PKD, and considered the potential therapeutic approaches targeted to slow cyst growth in PKD.

Effect of catheter choice during embryo transfer on the clinical outcome of in vitro fertilization-embryo transfer / 北京大学学报(医学版)

Objective:To compare two flexible embryo catheters and determine whether clinical out-come differs in the in vitro fertilization-embryo transfer (IVF-ET)cycles.Methods:This prospective control study was conducted by one doctor between July 2012 and November 2013.In the study,2 064 patients undergoing fresh embryo transfer by using IVF-ET/intracytoplasmic sperm injection (ICSI)-ET in Reproductive Medical Center of Peking University Third Hospital were recruited.The subjects were di-vided into two groups.Cook Sydney IVF embryo transfer catheters (product model:K-JETS-7019-SIVF) were used for embryo transfer in group 1 (n =949),and FrydmanCCD catheters (product model:131230301)were used in group 2 (n =1 115).Pregnancy outcomes were compared between these two groups.Results:There was no significant difference in age,diagnosis for infertility and stimulation proto-col used between the two groups.In addition,there was no difference in the number of oocytes collected and in the number and score of embryos transferred.The significantly higher implantation rate,clinical pregnancy rate,and live birth rate (34.40% vs.26.92%,51.21% vs.41.52%,42.57% vs. 33.09%,P 0.05).The proportion of difficult transfer was higher in group 1 than that in group 2 (5.27% vs.3.41%,P <0.05 ).There was no difference in the clinical pregnancy rate and live birth rate between the two difficult transfer cycles.Con-clusion:The type of embryo transfer catheter affects the clinical outcome in IVF.Good clinical outcome can be obtained by using Cook Sydney IVF catheter,which is worthy of clinical promotion.

Effects of oxidized low density lipoprotein on transformation of valvular myofibroblasts to osteoblast-like phenotype / 华中科技大学学报（医学）（英德文版）

In order to investigate the roles of Wnt signal pathway in transformation of cardiac valvular myofibroblasts to the osteoblast-like phenotype, the primary cultured porcine aortic valve myofibroblasts were incubated with oxidized low density lipoprotein (ox-LDL, 50 mg/L), and divided into four groups according to the ox-LDL treatment time: control group, ox-LDL 24-h group, ox-LDL 48-h group, and ox-LDL 72-h group. Wnt signal pathway blocker Dickkopf-1 (DDK-1, 100 μg/L) was added in ox-LDL 72-h group. The expression of a-smooth muscle actin (α-SMA), bone morphogenetic protein 2 (BMP2), alkaline phosphatase (ALP), and osteogenic transcription factor Cbfa-1 was detected by Western blotting, and that of β-catenin, a key mediator of Wnt signal pathway by immunocytochemical staining method. The Wnt/β-catenin was observed and the transformation of myofibroblasts to the osteoblast-like phenotype was examined. The expression of α-SMA, BMP2, ALP and Cbfa-1 proteins in the control group was weaker than in the ox-LDL-treated groups. In ox-LDL-treated groups, the protein expression of a-SMA, BMP2, ALP, and Cbfa-1 was significantly increased in a time-dependent manner as compared with the control group, and there was significant difference among the three ox-LDL-treated groups (P<0.05 for all); β-catenin protein was also up-regulated in the ox-LDL-treated groups in a time-dependent manner as compared with the control group (P<0.05), and its transfer from cytoplasm to nucleus and accumulation in the nucleus were increased in the same fashion (P<0.05). After addition of DKK-1, the expression of α-SMA, bone-related proteins and β-catenin protein was significantly reduced as compared with ox-LDL 72-h group (P<0.05). The Wnt/ β-catenin signaling pathway may play an important role in transformation of valvular myofibroblasts to the osteoblast-like phenotype.

Effects of oxidized low density lipoprotein on transformation of valvular myofibroblasts to osteoblast-like phenotype / 华中科技大学学报（医学）（英德文版）

In order to investigate the roles of Wnt signal pathway in transformation of cardiac valvular myofibroblasts to the osteoblast-like phenotype, the primary cultured porcine aortic valve myofibroblasts were incubated with oxidized low density lipoprotein (ox-LDL, 50 mg/L), and divided into four groups according to the ox-LDL treatment time: control group, ox-LDL 24-h group, ox-LDL 48-h group, and ox-LDL 72-h group. Wnt signal pathway blocker Dickkopf-1 (DDK-1, 100 μg/L) was added in ox-LDL 72-h group. The expression of a-smooth muscle actin (α-SMA), bone morphogenetic protein 2 (BMP2), alkaline phosphatase (ALP), and osteogenic transcription factor Cbfa-1 was detected by Western blotting, and that of β-catenin, a key mediator of Wnt signal pathway by immunocytochemical staining method. The Wnt/β-catenin was observed and the transformation of myofibroblasts to the osteoblast-like phenotype was examined. The expression of α-SMA, BMP2, ALP and Cbfa-1 proteins in the control group was weaker than in the ox-LDL-treated groups. In ox-LDL-treated groups, the protein expression of a-SMA, BMP2, ALP, and Cbfa-1 was significantly increased in a time-dependent manner as compared with the control group, and there was significant difference among the three ox-LDL-treated groups (P<0.05 for all); β-catenin protein was also up-regulated in the ox-LDL-treated groups in a time-dependent manner as compared with the control group (P<0.05), and its transfer from cytoplasm to nucleus and accumulation in the nucleus were increased in the same fashion (P<0.05). After addition of DKK-1, the expression of α-SMA, bone-related proteins and β-catenin protein was significantly reduced as compared with ox-LDL 72-h group (P<0.05). The Wnt/ β-catenin signaling pathway may play an important role in transformation of valvular myofibroblasts to the osteoblast-like phenotype.

Application of the vacuum sealing drainage technique combined with skin flap in chronic ulcerative wounds / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and efficacy of the vacuum sealing drainage (VSD) technique combined with skin flap for the treatment of chronic ulcerative wounds.</p><p><b>METHODS</b>From June 2009 to Aug. 2011, the VSD technique combined with skin flap has been applied in the treatment of 15 patients with chronic ulcerative wounds caused by various reasons. The VSD was applied to the wound for 1-6 times. When infection was controlled and fresh granulation grew, skin flap was used to cover the wound.</p><p><b>RESULTS</b>Flap necrosis happened in a small area at the distal end in one case, which healed after skin graft. All the other flaps survived with primary healing. The patients were followed up for 6-24 months postoperatively with no recurrence of infection.</p><p><b>CONCLUSIONS</b>VSD combined with skin flap is an ideal choice for reconstruction of chronic ulcerative wounds. It has the advantages of low complications, reliable flap survival rate, and low infection recurrence.</p>

Risk factors for initial bowel resection and postoperative recurrence in patients with Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors for the initial bowel resection and postoperative recurrence in a cohort of patients with Crohn disease(CD).</p><p><b>METHODS</b>A total of 216 consecutive patients who were regularly followed up in the Department of Gastroenterology at the First Affiliated Hospital of Sun Yat-sen University between 2003 and 2009 were included. Probabilities for initial intestinal resection were calculated with Kaplan-Meier method. The influence of concomitant covariates on the cumulative probability rates was examined using Cox proportional hazard model. The risk of postoperative recurrence, including endoscopic recurrence, clinical recurrence and surgical recurrence, was also investigated during the follow-up. Logistic analysis was performed for the risk factors of recurrence.</p><p><b>RESULTS</b>The median follow-up was 55 months. A total of 44 patients(20.4%) underwent bowel resection. The cumulative frequency of surgery was 11%, 25%, and 45% at 1, 5, and 10 years after initial onset. Multivariate analyses showed that age at diagnosis and disease behavior were independent risk factors for initial intestinal resection(P<0.05). All but 4 patients had complete follow-up after the surgery with a median duration of 20.4 months. Endoscopic recurrence rate was 52.6% within 1 year, and clinical recurrence rate was 22.5%. Median time to clinical recurrence was 22.6 months. Multivariate analyses showed that perianal disease was the only independent risk factor for clinical recurrence(P<0.05). During the follow-up 2 patients(5%) underwent further operation and both had the same indications for the reoperation as that for the initial surgery.</p><p><b>CONCLUSIONS</b>Patients with CD have a high frequency of surgery and the postoperative recurrent rate is also high. Age at diagnosis and disease behavior are associated with the probability of initial surgery. The presence of perianal disease is associated with a higher risk of clinical recurrence.</p>