Achievements of thyroid surgery in China in recent ten years / 西安交通大学学报(医学版)

In the past decade,thyroid surgery in China has developed rapidly.With the improvement of thyroid diagnosis technology,the standardization of thyroid surgery,the clinical application of systematic therapy,and the progress in fundamental research,thyroid surgery has achieved all-round development.Patients with thyroid disease have benefited significantly from safer,more standardized,more effective,and more diverse treatments,which results in the remarkable increase in the 5-year survival rate.Moreover,Chinese experts have published a number of guidelines and expert consensus related to thyroid surgery,which promotes the standardization of the diagnosis and treatment of thyroid disease.Additionally,the specialized multidisciplinary teams in cancer centers allow patients to receive more standardized diagnosis and treatment of complex thyroid diseases.In the present article,we summarize the important developments of China's thyroid surgery in the past decade,including preoperative diagnosis technology,surgical methods,operation safety,application of minimally invasive techniques,diagnosis and treatment of special thyroid cancers,multidisciplinary diagnosis and treatment models,and standardized postoperative managements.We expect to popularize the concept of standardized diagnosis and treatment of thyroid diseases,and improve the level of standardized diagnosis and treatment in thyroid surgery.

Construction of the second classroom system for college students based on the cultivation of innovation and entrepreneurship ability / 中华医学教育探索杂志

Taking medical statistics major in Binzhou Medical University as an example, based on the outcome-based education theory, in order to enhance the innovation ability of university students, we put forward the systematic second classroom training system, including improving the personnel training system, implementing education, experiment teaching reform, and practice teaching reform. It has achieved outstanding results in the discipline competition, improved social service ability and high degree of employer satisfaction. The systematic second-class talent training system based on the outcome-based education theory can provide reference for other medical colleges and related applied majors.

Genome-wide analysis identify novel germline genetic variations in ADCY1 influencing platinum-based chemotherapy response in non-small cell lung cancer

To explore the pharmacogenomic markers that affect the platinum-based chemotherapy response in non-small-cell lung carcinoma (NSCLC), we performed a two-cohort of genome-wide association studies (GWAS), including 34 for WES-based and 433 for microarray-based analyses, as well as two independent validation cohorts. After integrating the results of two studies, the genetic variations related to the platinum-based chemotherapy response were further determined by fine-mapping in 838 samples, and their potential functional impact were investigated by eQTL analysis and in vitro cell experiments. We found that a total of 68 variations were significant at P < 1 × 10-3 in cohort 1 discovery stage, of which 3 SNPs were verified in 262 independent samples. A total of 541 SNPs were significant at P < 1 × 10-4 in cohort 2 discovery stage, of which 8 SNPs were verified in 347 independent samples. Comparing the validated SNPs in two GWAS, ADCY1 gene was verified in both independent studies. The results of fine-mapping showed that the G allele carriers of ADCY1 rs2280496 and C allele carriers of rs189178649 were more likely to be resistant to platinum-based chemotherapy. In conclusion, our study found that rs2280496 and rs189178649 in ADCY1 gene were associated the sensitivity of platinum-based chemotherapy in NSCLC patients.

Selectively frequent expression of CXCR5 enhances resistance to apoptosis in CD8(+)CD34(+) T cells from patients with T-cell-lineage acute lymphocytic leukemia.

We investigated CD4(+)CD34(+), CD8(+)CD34(+), CD4(+)CD34(-), and CD8(+)CD34(-) T cells from cord blood and from typical patients with T-cell-lineage acute lymphocytic leukemia and T-cell-lineage chronic lymphocytic leukemia in terms of expression and functions of CXCR5/CXCL13. We found that CXCR5 was selectively frequently expressed on T-cell-lineage acute (chronic) lymphocytic leukemia (T-ALL) CD8(+)CD34(+) T cells, but not on T-ALL CD4(+)CD34(+), CD4(+)CD34(-), and CD8(+)CD34(-) T cells. CXCR5 was rarely expressed on all types of CD34(+) and CD34(-) CB or T-CLL T cells. CXCL13/B cells attracting chemokine 1 induced significant resistance to TNF-alpha-mediated apoptosis in T-ALL CD8(+)CD34(+) T cells, instead of induction of chemotactic and adhesive responsiveness. A proliferation-inducing ligand expression in T-ALL CD8(+)CD34(+) T cells was upregulated by CXCL13/BCA-1 (B-cell attracting chemokine 1). The CXCR5/CXCL13 pair by means of activation of APRIL (A proliferation-inducing ligand) induced resistance to apoptosis in T-ALL CD8(+)CD34(+) T cells in livin-dependent manner. In this process, cell-cell contact in culture was necessary. Based on our findings, we suggested that there were differential functions of CXCR5/CXCL13 in distinct types of cells. Normal lymphocytes, especially naive B and T cells, utilized CXCR5/CXCL13 for migration, homing, maturation, and cell homeostasis, as well as secondary lymphoid tissue organogenesis. Meanwhile, certain malignant cells took advantages of CXCR5/CXCL13 for infiltration, resistance to apoptosis, and inappropriate proliferation.

Selectively increased expression and functions of chemokine receptor CCR9 on CD4+ T cells from patients with T-cell lineage acute lymphocytic leukemia.

In a total of 38 typical T-cell lineage acute lymphocytic leukemia (T-ALL) and T-cell lineage chronic lymphocytic leukemia (T-CLL) cases investigated, we found that CC chemokine receptor CCR9 was selectively and frequently expressed on T-ALL CD4+ T cells, was moderately expressed on T-CLL CD4+ T cells, and was rarely expressed on normal CD4+ T cells. These findings were demonstrated at protein and mRNA levels using flow cytometry and real-time quantitative reverse transcription-PCR technique and were verified by digital confocal microscopy and Northern blotting. Thymus-expressed chemokine, a ligand for CCR9, selectively induced T-ALL CD4+ T-cell chemotaxis and adhesion. Interleukin (IL)-2 and IL-4, together, down-regulated the expression and functions of CCR9 in T-ALL CD4+ T cells including chemotaxis and adhesion. It was also demonstrated that IL-2 and IL-4, together, internalized CCR9 on T-ALL CD4+ T cells and subsequently inhibited functions of CCR9 in these cells. Thymus-expressed chemokine mRNA was highly expressed in CD4+ T cells, involving lymph node and skin in T-ALL patients, and was expressed at moderate levels in lymph node and skin tissues in T-CLL patients. Our findings may provide new clues to understanding various aspects of T-ALL CD4+ T cells, such as functional expression of CCR9-thymus-expressed chemokine receptor-ligand pairs as well as the effects of IL-2 and IL-4, which may be especially important in cytokine/chemokine environment for the pathophysiological events of T-ALL CD4+ T-cell trafficking.

CC chemokine ligand 25 enhances resistance to apoptosis in CD4+ T cells from patients with T-cell lineage acute and chronic lymphocytic leukemia by means of livin activation.

We investigated CD4 and CD8 double-positive thymocytes, CD4(+) T cells from typical patients with T-cell lineage acute lymphocytic leukemia (T-ALL) and T cell lineage chronic lymphocytic leukemia (T-CLL), and MOLT4 T cells in terms of CC chemokine ligand 25 (CCL25) functions of induction of resistance to tumor necrosis factor alpha (TNF-alpha)-mediated apoptosis. We found that CCL25 selectively enhanced resistance to TNF-alpha-mediated apoptosis in T-ALL and T-CLL CD4(+) T cells as well as in MOLT4 T cells, but CD4 and CD8 double-positive thymocytes did not. One member protein of the inhibitor of apoptosis protein (IAP) family, Livin, was selectively expressed in the malignant cells at higher levels, particularly in T-ALL CD4(+) T cells, in comparison with the expression in CD4 and CD8 double-positive thymocytes. After stimulation with CCL25 and apoptotic induction with TNF-alpha, the expression levels of Livin in these malignant cells were significantly increased. CCL25/thymus-expressed chemokine (TECK), by means of CC chemokine receptor 9 (CCR9) ligation, selectively activated Livin to enhance resistance to TNF-alpha-mediated apoptosis in c-jun-NH(2)-kinase 1 (JNK1) kinase-dependent manner. These findings suggested differential functions of CCR9/CCL25 in distinct types of cells. CD4 and CD8 double-positive thymocytes used CCR9/CCL25 for migration, homing, development, maturation, selection, cell homeostasis, whereas malignant cells, particularly T-ALL CD4(+) T cells, used CCR9/CCL25 for infiltration, resistance to apoptosis, and inappropriate proliferation.

Establishment and application of networked full-coverage multi-disciplinary team management mode under hospital administrative guidance / 中华医院管理杂志

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.

Anatomical changes and imaging manifestations of childhood developmental dysplasia of the hip / 中国组织工程研究

BACKGROUND: Developmental dysplasia of the hip is a common hip developmental deformity in children. Clinical treatment of developmental dysplasia of the hip differs in different periods. Early treatment has better efficacy, fewer complications, and better long-term prognosis. It can reduce the recurrence rate, reduce economic pressure, and improve the quality of life. Therefore, early diagnosis of developmental dysplasia of the hip is becoming more and more important clinically. OBJECTIVE: To review the research progress of anatomical changes and imaging manifestations of developmental dysplasia of the hip. METHODS: “DDH, Anatomy, X-ray Radiography, CT, MRI, Ultrasound” were used as English search terms. “Developmental hip dysplasia; anatomy; X-ray photography; CT; MRI, ultrasound” were used as Chinese search terms. The authors searched English databases such as PubMed and Springerlink, and Chinese databases such as Wanfang and CNKI from January 1990 to December 2019. Irrelevant and repetitive articles were excluded, and finally 55 articles were included for review. RESULTS AND CONCLUSION: Imaging diagnosis as a non-invasive examination method has become the preferred examination method for the diagnosis of developmental dysplasia of the hip, and its anatomical changes are more conducive to clinical imaging diagnosis. Routine X-ray examination can be used for rapid screening of developmental dysplasia of the hip. MRI helps to distinguish the early signal changes of soft tissue structure and bony structure. Three-dimensional CT can evaluate the acetabular bone structure changes from multiple angles, excluding the obstruction caused by posture factors. Ultrasonography is more sensitive to fluid and can also perform early screening of developmental dysplasia of the hip. Thus, different imaging examinations have their advantages and complement each other to improve the early diagnosis rate of developmental dysplasia of the hip.

Effect of calmodulin and its mutants on binding to Na1.2 IQ / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of calmodulin (CaM) and its mutants on binding to voltage-gated Na channel isoleucine-glutamine domain (Na1.2 IQ).@*METHODS@#The cDNA of Na1.2 IQ was constructed by PCR technique, CaM mutants CaM, CaM and CaM were constructed with Quickchange site-directed mutagenesis kit (QIAGEN). The binding of Na1.2 IQ to CaM and CaM mutants under calcium and calcium free conditions were detected by pull-down assay.@*RESULTS@#Na1.2 IQ and CaM were bound to each other at different calcium concentrations, while GST alone did not bind to CaM. The binding affinity of CaM and Na1.2 IQ at [Ca]-free was greater than that at 100 nmol/L [Ca] ( < 0.05). In the absence of calcium, the binding amount of CaM wild-type to Na1.2 IQ was greater than that of its mutant, and the binding affinity of CaM to Na1.2 IQ was the weakest among the three mutants ( < 0.05).@*CONCLUSIONS@#The binding ability of CaM and CaM mutants to Na1.2 IQ is Ca-dependent. This study has revealed a new mechanism of Na1.2 regulated by CaM, which would be useful for the study of ion channel related diseases.

Comparison of clinical efficacy between proximal gastrectomy with double tract reconstruction and total gastrectomy with Roux-en-Y reconstruction for proximal gastric cancer / 中华胃肠外科杂志

Objective@#To compare the clinical efficacy of proximal gastrectomy with double tract reconstruction (PG-DT) and total gastrectomy with Roux-en-Y reconstruction (TG-RY) for proximal gastric cancer.@*Methods@#The retrospective study was conducted. Clinicopathological data of 132 patients with proximal gastric cancer confirmed by pathology who underwent PG-DT (n=51) or TG-RY (n=81) by the same surgeon team in Southwest Hospital of Army Military Medical University between January 2006 and December 2016 were collected. Patients with preoperative neoadjuvant therapy, non-R0 resection and non-adenocarcinoma confirmed by pathology were excluded. Observation indicators included intraoperative (operation time and blood loss); postoperative (time to flatus, hospital stay, total complications, metastasis of lymph nodes around distal side of stomach from cases undergoing TG-RY), follow-up (long-term hemoglobin level, incidence of anemia, and survival) parameters. Survival analysis was conducted using the Kaplan-Meier method, and Log-rank test was used to compare survival difference between two groups.@*Results@#No statistically significant differences were found between two groups in the baseline data, including age, gender, BMI, hemoglobin level before operation, postoperative TNM stage, tumor size and histological differentiation between two groups (all P>0.05). There were no significant differences between PG-DT and TG-RY in intraoperative blood loss [200 (200) ml vs. 200 (195) ml, Z=-1.860, P=0.063], time to flatus [(2.7±1.0) days vs. (2.6±1.1) days, t=0.225, P=0.823], postoperative hospital stay [10(3) days vs. 10 (4) days, Z=-0.449, P=0.654] and morbidity of perioperative complications [5.9% (3/51) vs. 8.6% (7/81), χ2=0.081, P=0.775]. Compared with the TG-RY group, PG-DT group had longer total operative time [294 (97) minutes vs. 255 (71) minutes, Z=–3.148, P=0.002]. The hemoglobin data of 42 patients with PG-DT and 56 patients with TG-RY were collected 1 year after operation. The incidence of anemia in PG-DT group was lower than that of TG-RY group [64.2%(27/42) vs. 82.1% (46/56), χ2=4.072, P=0.045], and PG-DT group had higher level of hemoglobin than TG-RY group [(114.4±16.3) g/L vs. (106.6±15.0) g/L, t=2.435, P=0.017]. There were 4 cases (4/81, 4.9%) with metastasis of lymph nodes around distal side of stomach in TG-RY group. All of these 4 tumors were T4 in depth and were more than 5 cm in diameter. The median follow-up period was 26 (1 to 110) months. One-year, 3-year and 5-year survival rates were 93.2%, 65.3% and 55.0% in PG-DT group, and 85.8%, 63.8% and 47.2% in TG-RY group, respectively without significant difference (χ2=0.890, P=0.345).@*Conclusions@#Compared with TG-RY, PG-DT has the same safety and feasibility for proximal gastric cancer. Although the operative time is a little longer than TG-RY, PG-DT has advantages in improving the postoperative hemoglobin level.

Feasibility of robotic surgical system in radical gastrectomy for gastric cancer after liver transplantation / 中华胃肠外科杂志

OBJECTIVE@#To explore the feasibility and safety of robotic surgical system for radical gastrectomy after liver transplantation.@*METHODS@#A 65-year-old male patient with gastric cancer after liver transplantation underwent radical distal subtotal gastrectomy using Da Vinci surgical system at the General Surgery Department of Southwest Hospital Affiliated to the Army Military Medical University on October 23,2018. The placement of Trocars was arranged using five-hole method. No metastatic tumors were found during intraperitoneal exploration and the first hepatic hilum was found to be wrapped with omentum majus. The tumor located at gastric antrum near the lesser curvature. Then the first and the second station lymph nodes were dissected successively. Distal gastrectomy, Billroth II and Brown anastomosis were performed. The anatomical changes of upper abdomen and gastric lymph reflux after liver transplantation were analyzed.@*RESULTS@#Radical distal gastrectomy with D2 lymphadenectomy was successfully performed under the whole robotic surgical system. The operative time was 315 minutes,and blood loss was 145 ml. A total of 19 lymph nodes were dissected, of which 11 were metastatic lymph nodes. The operative difficulty was to separate the adhesion around the hepatic hilum precisely so as to avoid the damage of hepatic surface, as well as the colon hepatic flexure and duodenum which were closely adhered to hepatic hilum. Meanwhile,it was necessary to pay attention to protetion for the common bile duct and portal vein. The endoscopic wrist joint of the robot surgical system was flexible and delicate, which had obvious advantages in the process of anatomical separation of the adhesions among organs and adhesions around denuded common hepatic artery without normal vascular sheath. Semi-liquid diet was provided on the third day after operation. The immunosuppressants were resumed on the third day after operation. The patient was discharged on the 7th day postoperatively without any complications. There were no abdominal bleeding, incision infection,anastomotic leakage, anastomotic stenosis and other complications. Two months after operation, the patients diet and daily life is normal.@*CONCLUSION@#The robotic surgical system is safe and feasible for gastric cancer surgery after liver transplantation.

Pharmacogenetic Correlates of Antipsychotic-Induced Weight Gain in the Chinese Population / 神经科学通报·英文版

Antipsychotic-induced weight gain (AIWG) is a common adverse effect of this treatment, particularly with second-generation antipsychotics, and it is a major health problem around the world. We aimed to review the progress of pharmacogenetic studies on AIWG in the Chinese population to compare the results for Chinese with other ethnic populations, identify the limitations and problems of current studies, and provide future research directions in China. Both English and Chinese electronic databases were searched to identify eligible studies. We determined that > 25 single-nucleotide polymorphisms in 19 genes have been investigated in association with AIWG in Chinese patients over the past few decades. HTR2C rs3813929 is the most frequently studied single-nucleotide polymorphism, and it seems to be the most strongly associated with AIWG in the Chinese population. However, many genes that have been reported to be associated with AIWG in other ethnic populations have not been included in Chinese studies. To explain the pharmacogenetic reasons for AIWG in the Chinese population, genome-wide association studies and multiple-center, standard, unified, and large samples are needed.

Curative effect of entecavir combined with glucocorticoid in the treatment of early stage hepatitis B liver failure / 中国医师进修杂志

Objective To observe the curative effect of entecavir combined with glucocorticoid in early stage hepatitis B liver failure. Methods The clinical data of 100 patients with early stage hepatitis B liver failure from February 2012 to February 2017 were retrospectively analyzed. Among them, 50 patients were treated with entecavir combined with glucocorticoid (treatment group), and 50 patients were treated with entecavir (control group). The alanine aminotransferase (ALT), total bilirubin (TBil), total cholesterol (TC), prothrombin activity (PTA), hepatitis B virus (HBV)-DNA, tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 levels were compared between 2 groups. Results The ALT, TBil, TC and PTA levels 1, 2, 4 and 8 weeks after treatment in treatment group were significantly lower than those in control group, and there were statistical differences (P<0.05); there was no statistical difference in HBV-DNA between 2 groups (P>0.05). The TNF-α, IL-6 and IL-10 levels 4 weeks after treatment in treatment group were significantly lower than those in control group: (2.5 ± 0.5) μg/L vs. (3.2 ± 0.7) μg/L, (16.8 ± 2.2) μg/L vs. (22.1 ± 2.4) μg/L and (7.3 ± 1.2) μg/L vs. (9.1 ± 1.8) μg/L, and there were statistical differences (P<0.05). Eight weeks after treatment, the effective rate and survival rate in treatment group were significantly higher than those in control group: 80％ (40/50) vs. 54％ (27/50) and 94％ (47/50) vs. 78％ (39/50), and there were statistical differences (P<0.01 or <0.05).In the treatment group, there was no serious adverse reaction during glucocorticoid therapy,and the patients recovered after withdrawal or reduction of glucocorticoid. Conclusions Entecavir combined with glucocorticoid has a significant effect on patients with early stage hepatitis B liver failure. It could improve survival rate, and the adverse effects of glucocorticoid are less.

Analysis of clinical characteristics and death risk factors in patients infected with severe fever with thrombocytopenia syndrome bunyavirus / 中国医师进修杂志

Objective The study the clinical characteristics and death risk factors in patients infected with severe fever with thrombocytopenia syndrome bunyavirus (SFTSV). Methods The clinical data of 56 patients infected with SFTSV from May 2011 to October 2016 were retrospectively analyzed. The clinical characteristics and laboratory examination results were compared between cured patients and death patients. The death risk factors were analyzed by two classification Logistic regression analysis. Results Among the 56 cases, 40 cases were cured and 16 cases were dead, and the time of onset to death was (12 ± 3) d. All patients showed symptoms including fever and weakness. Bone marrow biopsy was performed in 26 cases, and hemophagocytic phenomenon was found in 21 cases. Compared with cured patients, the death patients were older; the rate of underlying diseases was higher; fever time was longer; the incidences of skin and/ or gastrointestinal bleeding, neuropsychiatric symptoms, abnormal troponin and arrhythmias were higher, platelet, CD4+and CD8+were lower; the levels of activated partial thromboplastin time (APTT), creatine kinase (CK), lactate dehydrogenase (LDH), viral load, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were higher, and there were statistical differences (P＜0.01 or ＜0.05). Two classification Logistic regression analysis result showed that viral load ≥ 5 lgTCID50/ml, age ≥ 70 years, platelet ＜ 20 × 109/L, CK ＞ 1 200 U/L, fever time ＞ 8 d, APTT ≥ 120 s, troponin elevation and neuropsychiatric symptoms were the independent risk factors of death in patients infected with SFTSV (P＜0.01 or＜0.05). Conclusions The high viral load, high age, lower platelet, increased CK, prolonged fever time and APTT, elevated troponin and neuropsychiatric symptoms were independent risk factors of death in patients infected with SFTSV. Early identification for the risk factors of death may improve the prognosis.

Application of robotic surgery to treat carcinoma in the remnant stomach / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the surgical techniques and feasibility of robotic surgery for carcinoma in the remnant stomach(CRS).</p><p><b>METHODS</b>Clinicopathological data of 20 CRS patients undergoing robotic surgery at the Minimally Invasive Center for Gastrointestinal Surgery, Army Medical University Southwest Hospital from November 2012 to October 2017 were retrospectively collected. The surgical methods, procedures, main difficulties, and key techniques were analyzed, and the clinical efficacy was evaluated.</p><p><b>RESULTS</b>Among 20 CRS patients, 14 were male and 6 were female with mean age of 59.9 years and mean BMI of 19.7 kg/m. For the primary diseases, 17 patients underwent laparotomy, 3 underwent laparoscopic radical resection of gastric cancer; 18 cases received distal subtotal gastrectomy plus Billroth II( anastomosis, 2 received distal subtotal gastrectomy plus Billroth I( anastomosis. CRS located in anastomotic stoma in 15 cases and in the gastric fundus and cardiac part in 5 cases. Preoperative staging revealed 2 cases of T2NxM0, 1 of T3NxM0, 2 of TxNxM0 and 15 of T4aNxM0. Sixteen patients received robotic surgery with Roux-en-Y reconstruction successfully, and 4 patients were converted to laparotomy for palliative total gastrectomy, including 1 case with diaphragm invasion, 1 case with transverse colon invasion, and 2 cases with tight adhesions. The mean surgery time was (255±35) minutes, mean blood loss was (230±50) ml, mean number of dissected lymph nodes was 19.5±3.0, mean recovery time to gastrointestinal function was (2.3±1.0) days, mean time to feeding was (2.3±1.0) days, and mean time to ambulatory activity was (2.5±0.5) days. Pathological examinations revealed 12 patients with poorly differentiated adenocarcinoma, 6 patients with moderately differentiated adenocarcinoma, and 2 patients with mucinous adenocarcinoma. Postoperative pTNM staging was identified as follows: stage I(B for 1 patient, stage II(A for 2 patients, stage II(B for 5 patients, stage III(A for 5 patients, stage III(B for 4 patients, and stage III(C for 3 patients. One patient died 2 weeks after operation due to multiple organ failure. One patient received another hemostasis operation due to hemorrhage of splenic artery and recovered postoperatively. Two patients experienced anastomotic leakage, 1 patient developed duodenal stump fistula and 1 patient experienced incision site infection postoperatively, and all of them recovered after conservative treatment. During 5-60 months follow-up, 10 cases died and 10 cases survived, including 1 case for 6 years.</p><p><b>CONCLUSIONS</b>Robotic surgery for CRS is feasible with satisfactory short-term efficacy. However, the long-term efficacy requires further study.</p>

Issues and countermeasures in utilization and management of scientific research funds / 中华医学科研管理杂志

Objective To understand the current situation and problems of scientific research funds using in scientific institutions in order to explore possible solutions.Methods Five financial department directors of municipal medical research institutions and eight project investigators under the supervision of higher authorities have been interviewed,information data was analyzed by the subject framework method.Results Certain problems were identified during the use of scientific research funds,for example,unprofessional budgeting,lack of compliance during the using process,inappropriate management of budget adjustment,left over funds and so on.Conclusions Some possible solutions were proposed in this article,for instance,strengthen the discretion of scientific research funds management,setting up the financial assistant system of scientific research funds,construction of informative accounting management platform.

Clinical Observation of Amlodipine Besylate Combined with Lisinopril and Hydrochlorothiazide,Atorvas-tatin in the Treatment of Severe Primary Hypertension Complicating with Carotid Atherosclerosis / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of amlodipine besylate combined with lisinopril and hydro-chlorothiazide,atorvastatin in the treatment of severe primary hypertension complicating with carotid atherosclerosis. METHODS:90 patients with severe primary hypertension complicating with carotid atherosclerosis were divided into control group (45 cases) and observation group(45 cases)according to random lottery form. Both groups were given Atorvastatin calcium tablet 20 mg/time orally,qd;control group was additionally given Amlodipine besylate tablet 5 mg/time orally,qd;observation group was additional-ly given Lisinopril and hydrochlorothiazide tablet 10 mg/time orally,qd,on the basis of control group. Both groups were treated for 8 weeks. Clinical efficacies of 2 groups were compared as well as blood pressure level,IMT,PV of carotid atherosclerosis, hs-CRP,TNF-α before and after treatment. The occurrence of ADR was recorded. RESULTS:Total response rate of observation group was significantly higher than that of control group,with statistical significance (P0.05). After treatment,the levels of SBP,DBP, IMT,PV,hs-CRP and TNF-α level in 2 groups were significantly lower than before;the observation group was significantly lower than the control group,with statistical significance (P0.05). CONCLUSIONS:Amlodipine besylate combined with lisinopril and hydrochlorothiazide,atorvastatin in the treatment of primary hypertension complicating with carotid atherosclerosis can effectively control the blood pressure level, delay the progression process of carotid atherosclerosis,reduce the inflammatory reaction degree,but dose not increase the occur-rence of ADR with good safety.

Preliminary Research for the Effect of Growth Hormone Releasing Peptide on Myocardial Cell Apoptosis in Heart Failure Rats / 中国循环杂志

To explore the effect of growth hormone releasing peptide (GHRP) on myocardial cell apoptosis in heart failure (HF) rats. Methods: Rat's HF model was established by the ligation of left anterior descending coronary artery induced ischemia. 40 male SD rats were randomly assigned into 4 groups: Normal control group, Sham operation group, HF group and GHRP treated HF group. n=10 in each group and the rats were fed for 4 weeks after the operation. Cardiac function was examined and myocardial cell morphology was observed; protein expressions of Smac/DIABL0 and Bcl-2 were measured by Western blot analysis; cell apoptosis was evaluated by FCM technique. The differences for above parameters were compared among groups to explore the effect of GHRP on myocardial cell apoptosis in HF rats. Results: Compared with HF group, GHRP treated HF group showed the less heart dilation, higher LVEF, lighter pathological changes in myocardial cells and decreased protein expression of Smac/DIABL0, all P<0.05. Bcl-2 level was lower in HF group than the other 3 groups, P<0.05. Compare with Normal control group, GHRP treated HF group had elevated Bcl-2 level, all P<0.05. Myocardial cell apoptosis index was different between HF group and GHRP treated HF group, P<0.05. Conclusion: The effect of GHRP on anti-HF should be via inhibiting myocardial cell apoptosis; the mechanism may partly be through promoting Bcl-2 protein expression and depressing Smac/DIABLO mediated mitochondrial pathway of apoptosis.