Effect of Compound Phylanthus urinaria Ⅱ in Regulating Expression of lncRNA CCAT1 in Hepatocellular Carcinoma HepG2 Cells / 中国实验方剂学杂志

Objective:To explore the anti-hepatoma effect of compound <italic>Phylanthus urinaria</italic> Ⅱ （ CPU Ⅱ） by inhibiting the expression of the long non-coding RNA （lncRNA） colon cancer associated transcript-1 （CCAT1） and restoring the expression of microRNA let-7a. Method:Real-time fluorescence quantitative polymerase chain reaction （PCR） was used to detect the expression of lncRNA CCAT1 in normal liver cells （LO2 cells） and hepatocellular carcinoma HepG2 cells， and the differences in expression between these two types of cells were compared. The methylthiazolyl tetrazolium（MTT） assay was used to detect the proliferation of HepG2 cells after treatment with different concentrations of CPU Ⅱ and 5-fluorouracil（5-FU） for 24， 48 and 72 h. Hepatocellular carcinoma HepG2 cells were cultured <italic>in vitro </italic>and set into three gropes： cell control group， CPU Ⅱ low-dose group （0.8 g·L^-1） and high-dose group （1.6 g·L^-1）. Real-time PCR was used to detect the mRNA expression of lncRNA CCAT1， microRNA let-7a and its target genes high mobility group protein A2（HMGA2）， and N-RAS in each grope. Western blot was used to detect the protein expression of HMGA2， and Cyclin D₁ in each grope. Result:As compared with LO2 cells， expression of lncRNA CCAT1 in HepG2 cells was significantly up-regulated （<italic>P</italic><0.05）. Results of MTT assay showed that the 50% inhibiting concentration（IC₅₀）of CPU Ⅱ and 5-FU on hepatocellular carcinoma HepG2 cells was 1.649， 0.044 648 g·L^-1respectively. As compared with the control group， CPU Ⅱ high-and low-dose groups （1.6， 0.8 g·L^-1） significantly inhibited the proliferation of HepG2 cells （<italic>P</italic><0.05）， and the effect was most remarkable in CPU Ⅱ high-dose group （<italic>P</italic><0.05）. The results of Real-time PCR showed that as compared with control group， the expression of lncRNA CCAT1 mRNA was significantly inhibited in CPU Ⅱ high-and low-dose groups （<italic>P</italic><0.05）， and the expression of microRNA let-7a mRNA was obviously up-regulated in high-dose group （<italic>P</italic><0.05）， but the expression of HMGA2 mRNA in CPU Ⅱ high-and low-dose groups as well as the expression of N-RAS mRNA in CPU Ⅱ low-dose group were down-regulated （<italic>P</italic><0.05）. Western blot results showed that as compared with the cell control group， the protein expression of HMGA2 and Cyclin D₁ in CPU Ⅱ high-and low-dose groups （1.6， 0.8 g·L^-1） was significantly down-regulated （<italic>P</italic><0.05）. Conclusion:CPU Ⅱ can inhibit the expression of lncRNA CCAT1， recover the expression of microRNA let-7a， and suppress the mRNA and protein expression of related downstream target genes in hepatoma cells line HepG2， thereby inhibiting the proliferation of hepatocellular carcinoma cells and exerting anti-hepatocellular carcinoma effect.

Prevention of diabetic foot complications

This paper discussed the importance of prevention of diabetic foot ulcers and our institution's protocol for prevention, reviewing the existing evidence in the literature regarding the effectiveness of the preventive approach. Diabetes mellitus is the second most significant cause of disease in Singapore after ischaemic heart disease. National University Hospital, Singapore, adopts a two-pronged strategy for the management of diabetic foot ulcers. The most important strategy is prevention, and education is key. Education should mainly be directed at patients and caregivers, but also professionals (general practitioners, allied health professionals and nurses) so that they can effectively educate patients and caregivers. Patient education includes care of diabetes mellitus, care of the foot and use of appropriate footwear. Patients also tend to have poor foot hygiene. Annual foot screening for diagnosed diabetics plays an important role. However, prolonged and sustained government intervention is necessary to provide education and screening on a national scale.

Transoral penetrating craniocerebral injury by a bamboo chopstick in a child.

We present a 3-year-old girl with a transoral injury by a bamboo chopstick penetrating the middle skull base. The features of imaging are described and the management is discussed. The potential for injury to the cavernous sinus is emphasized, even if no there is no hemorrhage on the initial CT scan. Early intracranial infection in relation to penetrating injuries is a factor in planning treatment by craniotomy.

Genetic characterization of enterovirus 71 isolated from patients with severe disease by comparative analysis of complete genomes.

Enterovirus 71 (EV71) which causes mild illness in children is also associated with severe neurological complications. This study analyzed the complete genomes of EV71 strains derived from mild and severe diseases in order to determine whether the differences of EV71 genomes were responsible for different clinical presentations. Compared to complete genomes of EV71 strains derived from mild cases (less virulent strains), nucleotide differences in EV71 strains isolated from severe cases (more virulent strains) were observed primarily in the internal ribosomal entry site (IRES) of the 5'-untranslated region (UTR), which is vital for the cap-independent translation of viral proteins. In the protein-coding region, an E-Q substitution at amino acid position 145 of structural protein VP1 that occurred in more than one of more virulent strains was observed. This site is known to be related functionally to receptor binding and virulence in mice. Overall, strains (Group III) isolated from patients with fatal or severe sequelae outcomes had greater sequence substitutions in the 5'-UTR and/or protein-coding region and exhibited a relatively low-average homology to less virulent strains across the entire genome, indicating the possibility of significant genomic diversity in the most virulent EV71 strains. Further studies of EV71 pathogenesis should examine the significance of genomic diversity and the effects of multiple mutations in a viral population.

Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009.

BACKGROUND: Isolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children. METHODS: From January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children's hospital. Two hundred and ninety-six (6.3%) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6%) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses. RESULTS: There were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5% in 2007 and up to 22.2% in 2009. The mean age of inpatients was 2.42 ± 0.14 years. The mean hospitalization duration was 4.21 ± 0.11 days. The most common symptoms were fever (100%), oral ulcers (90.8%), and decreased oral intake (89.4%). The mean duration of fever was 2.78 ± 1 days (range, 1-7 days). Seventy-seven (54.6%) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm(3), and 63 (45%) patients had leukocytosis (>15,000/mm(3)). The mean serum C-reactive protein (CRP) level was 44.1 ± 3.3 mg/L (normal, <10 mg/L) and 62 (44%) had a CRP level >40 mg/L. One hundred and eight (76.6%) inpatients were diagnosed as herpangina and 18 (12.8%) hand-foot-mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully. CONCLUSIONS: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

[Investigation on dermal contamination among workers occupationally exposed to dimethylformamide].

OBJECTIVE: To establish a method for the determination of dimethylformamide (DMF) and investigate dermal contamination and absorption among workers occupationally exposed to DMF. METHOD: 37 workers exposed to DMF were divided randomly into two groups. DMF was washed down by isopropyl alcohol in A group (16 workers) and water in B group(21 workers).Gas chromatography was used for the quantification of dermal contamination and N-methylformamide(NMF) in urine, correlative study was done between them. RESULTS: DMF could be detected in all samples in A group, but could not be detected in B group. The miscellaneous peaks could be completely separated from the DMF peak in the sample spectrum, without manual inference. The highest degree of total dermal contamination was observed in wet spinning workshop [(2.84 +/- 1.31) mg], postprocessing workshop [(2.50 +/- 0.95) mg] and dry spinning workshop [(1.95 +/- 0.61) mg] were lower. The respiratory cumulative exposure dosages were 351.3, 201.3 and 135.2 mg respectively. The average DMP concentration in air of the third printing processing workshop, the dry spinning workshop and the wet spinning workshop was 60.2, 89.6, 156.4 mg/m3 respectively, and the respiratory tract contamination in the workers of the three workshops were 135.2, 201.3 and 351.3 mg respectively. There was statistical independence between the quantification of total dermal contamination and NMF in urine (r = 0.176, P > 0.05). CONCLUSION: Isopropyl alcohol is the effective washing solvent.When the concentration of DMF in workplace air is above the occupational exposure limit, respiratory tract absorption is the principal pathway of DMF absorption,but dermal contamination of DMF should not be ignored.

Clinical features of echovirus 6 and 9 infections in children.

BACKGROUND: Clinical features of echovirus 6 and 9 infections in children have not been comprehensively evaluated, particularly for sporadic cases. OBJECTIVE: To describe the clinical features of children with echovirus 6 or 9 infections. STUDY DESIGNS: From 2000 to 2008, 199 children with culture-proven echovirus 6 or 9 infections identified in a university-affiliated hospital were included. Data extracted from 174 inpatients were further analyzed. RESULTS: Age ranged from 4 days to 15 years with a mean of 4.7 years. 123 (62%) were male. The disease spectrums were similar for echovirus 6 (n=100) and 9 (n=74) infections, with aseptic meningitis (49% and 51%, respectively) being the most common syndrome, followed by meningismus, upper respiratory tract infection, pneumonia, and herpangina. All 174 inpatients had fever but the duration of fever was significantly longer in patient with echovirus 9 infection than those with echovirus 6 infections (6.0 days vs. 3.8 days, p<0.001). The rate of leukocytosis (leukocyte count>15,000/µL) were significantly higher in patients with echovirus 6 infections than those with echovirus 9 infection (p<0.001). One neonate with echovirus 6 infection died from hepatic necrosis with coagulopathy, and one infant with echovirus 6 infection and one child with echovirus 9 infection died from brain involvement. Two children had long-term sequelae of seizure disorder. The remaining 169 children (97%) recovered uneventfully. CONCLUSION: For children with echovirus 6 or 9 infections requiring hospitalization, aseptic meningitis was the most common manifestation and fatal outcome or long-term sequel, though rare, might occur.

An investigation of epidemic enterovirus 71 infection in Taiwan, 2008: clinical, virologic, and serologic features.

BACKGROUND: Enterovirus 71 (EV71) is causing life-threatening hand-foot-mouth disease in Asia. In Taiwan, EV71 epidemics with different predominant genotypes occurred in 1998 (C2), 2000-2001 (B4), and 2004-2005 (C4). This genotype replacement may have important implications for vaccine development and prediction of epidemics. A nationwide EV71 outbreak occurred again in 2008, which provided a unique opportunity to characterize clinical, virologic, and serologic features of this epidemic. METHODS: We analyzed clinical and virologic data of 111 EV71 patients hospitalized in 2008 and prospectively conducted follow-ups of healthy children from June 2006 to December 2008. RESULTS: Among the 111 EV71 inpatients, 21 (19%) developed complications. Among the 21 complicated cases, 15 had central nervous system complication only, 2 had acute heart failure, and 4 had central nervous system and pulmonary complications. In the prospective study, 11 symptomatic infections and 4 asymptomatic infections were detected. Twenty-two EV71 isolates were genotyped, and 21 of them belong to genotype B5, which is phylogenetically close to B5 viruses circulating in Southeast Asia. Serologic tests show that children infected with B5 viruses have lower geometric mean titers of neutralizing antibody against genotype C4 than those against genotype B5 (P = 0.004, t test). CONCLUSIONS: The 2008 nationwide EV71 epidemic was caused by genotype B5 that was likely introduced to Taiwan from Southeast Asia. Clinical features of the 2008 epidemic were not different from those observed before in Taiwan. Potential antigenic variations between genotype C4 and B5 viruses could be detected and its long-term epidemiologic significance needs further investigation to clarify.

Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children's hospital experience.

BACKGROUND/PURPOSE: Coxsackievirus A2 (Cox A2) was the predominant serotype in the enterovirus outbreak in Taiwan, 2008. However, detailed clinical features of Cox A2 infection have not been reported. In this study, we compared Cox A2 with enterovirus 71 (EV71) in terms of clinical manifestation and epidemiology during the 2008 enterovirus outbreak in Taiwan. METHODS: A total of 280 hospitalized patients (97 with culture-proven EV71 infection and 183 with culture-proven Cox A2 infection) in 2008 at the Chang Gung Children's Medical Center were enrolled in this study. Epidemiologic data, clinical manifestations, and outcomes for these patients were collected and compared. RESULTS: Both Cox A2 and EV71 serotypes peaked in June and declined soon afterwards. Seventy-one percent of the patients were younger than 3 years of age. Both groups had the same male-to-female ratio of 1.6:1. Patients with EV71 infection had a significantly longer hospitalization period (4.1 vs. 3.0 days, p< 0.001). Fever, fever for more than 3 days with a temperature above 39 degrees C, lethargy, poor activity, poor appetite and a myoclonic jerk were significantly associated with EV71 infection. Fever, or fever with a temperature above 39 degrees C, febrile seizure, elevated white cell counts, and elevated serum C-reactive protein concentrations were significantly associated with Cox A2 infection. Most patients with EV71 infection presented with hand-foot-mouth disease (78.3%), while most Cox A2-infected patients presented with herpangina (83.6%). Central nervous system complications were found in 18.6% of EV71-infected children, but only in 1.1% of Cox A2-infected children. All the patients with Cox A2 infection showed total recovery. One patient with EV71 infection died from encephalitis with cardiopulmonary failure, and 6.2% of EV71-infected children had neurologic sequelae. CONCLUSION: Both Cox A2 and EV71 serotypes accounted for the enterovirus outbreak in Taiwanese children in 2008. Compared with those infected by EV71, the children with Cox A2 infection mostly presented with herpangina, had fewer central nervous system complications, and had better overall outcome.

Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhea.

BACKGROUND: Acute infectious diarrhea is a major cause of childhood morbidity and economic burden for families. We evaluate the clinical, microbiologic, and immunologic effects of probiotics in acute infectious diarrhea. METHODS: Children (n = 304) aged 3 months to 6 years hospitalized for acute diarrhea were randomized to receive Bio-three (a mixture of Bacillus mesentericus, Enterococcus faecalis, and Clostridium butyricum) or placebo orally 3 times daily for 7 days. Fecal samples were homogenized for bacterial culture and blood cells were isolated for cell culture and cytokine analysis. This study is registered (NCT00463190). RESULTS: The mean duration of diarrhea after start of therapy was 60.1 hours in the probiotics group versus 86.3 hours in the placebo group (P = 0.003). Hospital stay was shorter in the probiotics group than in the placebo group (P = 0.009). Counts of Bifidobacteria and Lactobacillus species were elevated in stool culture of the probiotics (Bio-three) group. IL-10 was increased in the serum and supernatants of cell culture in the probiotics group, and tumor necrosis factor-alpha values were down-regulated. Interferon- gamma and IL-12 were mildly elevated in the probiotics group, compared with the placebo group. CONCLUSIONS: This probiotics mixture reduced the severity of diarrhea and length of hospital stay in children with acute diarrhea. In addition to restoring beneficial intestinal flora, probiotics may enhance host protective immunity such as down-regulation of pro-inflammatory cytokines and up-regulation of anti-inflammatory cytokines.

Large cystic hypoglossal schwannoma with fluid-fluid level: a case report.

Hypoglossal schwannomas are rare skull base tumors. Furthermore, cystic hypoglossal schwannomas are extremely uncommon. We report the first case of a large cystic hypoglossal schwannoma with a fluid-fluid level. A 36-year-old woman presented with increased intracranial pressure and cerebellar signs without hypoglossal nerve palsy. Magnetic resonance imaging showed a predominantly cystic mass with a fluid-fluid level in the foramen magnum region extending into the hypoglossal canal. The intracranial tumor was largely removed via a midline suboccipital subtonsillar approach, leaving only a tiny residue in the hypoglossal canal. Histology confirmed a schwannoma with relative hypervascularity. Twenty months later, the tumor recurred and presented as a multicystic dumbbell-shaped lesion, extending intra- and extracranially through the enlarged hypoglossal canal. A complete resection of the intracranial and intracanalicular parts of the tumor was achieved with a small extracranial remnant treated by radiosurgery. Histology revealed a focal increased K(i)67 proliferative index. In this report, we discuss the possible reasons for the absence of hypoglossal nerve palsy and the potential mechanism of the formation of the fluid-fluid level, and we consider the treatment of this lesion.

Boostrix: a reduced-dose acellular pertussis vaccine for use in adolescents and adults.

Pertussis remains a serious problem in many countries. Even in countries with high vaccine coverage and a long vaccination history, pertussis outbreaks occur periodically. Rather than being a disease of young children, pertussis has shifted to affect adolescents and adults. Increased pertussis burden in adolescents and adults is the major source of severe infection for young infants. An effective vaccine is needed to control the spread of pertussis beyond preschool children. Boostrix is a reduced-dose acellular pertussis vaccine with diphtheria and tetanus toxoids, and is designed for use in adolescents and adults. Current evidence suggests that Boostrix is immunogenic and well tolerated. The pertussis component of Boostrix has been shown to be efficacious in a large-scale Phase III trial. More than 50 countries have given permit to the use of Boostrix, and many of them formally recommend the use of Boostrix in adolescents and adults. Designed as a vaccine for adolescence and adults, Boostrix has a long way to go to achieve large-scale use in those target groups. Nevertheless, we expect that the advent of Boostrix will lead to a much better control of pertussis in the general population.

Inhibition of autophagy induced by proteasome inhibition increases cell death in human SHG-44 glioma cells.

AIM: The ubiquitin-proteasome system (UPS) and lysosome-dependent macroautophagy (autophagy) are two major intracellular pathways for protein degradation. Recent studies suggest that proteasome inhibitors may reduce tumor growth and activate autophagy. Due to the dual roles of autophagy in tumor cell survival and death, the effect of autophagy on the destiny of glioma cells remains unclear. In this study, we sought to investigate whether inhibition of the proteasome can induce autophagy and the effects of autophagy on the fate of human SHG-44 glioma cells. METHODS: The proteasome inhibitor MG-132 was used to induce autophagy in SHG-44 glioma cells, and the effect of autophagy on the survival of SHG-44 glioma cells was investigated using an autophagy inhibitor 3-MA. Cell viability was measured by MTT assay. Apoptosis and cell cycle were detected by flow cytometry. The expression of autophagy related proteins was determined by Western blot. RESULTS: MG-132 inhibited cell proliferation, induced cell death and cell cycle arrest at G(2)/M phase, and activated autophagy in SHG-44 glioma cells. The expression of autophagy-related Beclin-1 and LC3-I was significantly up-regulated and part of LC3-I was converted into LC3-II. However, when SHG-44 glioma cells were co-treated with MG-132 and 3-MA, the cells became less viable, but cell death and cell numbers at G(2)/M phase increased. Moreover, the accumulation of acidic vesicular organelles was decreased, the expression of Beclin-1 and LC3 was significantly down-regulated and the conversion of LC3-II from LC3-I was also inhibited. CONCLUSION: Inhibition of the proteasome can induce autophagy in human SHG-44 glioma cells, and inhibition of autophagy increases cell death. This discovery may shed new light on the effect of autophagy on modulating the fate of SHG-44 glioma cells.Acta Pharmacologica Sinica (2009) 30: 1046-1052; doi: 10.1038/aps.2009.71.

Influenza-associated central nervous system dysfunction in Taiwanese children: clinical characteristics and outcomes with and without administration of oseltamivir.

Seventy-four of the 2651 patients (2.8%) with influenza aged <18 years had signs or symptoms of central nervous system dysfunction presenting to the hospital. None had oseltamivir exposure before the onset of central nervous system dysfunction. Seventeen children received oseltamivir therapy after admission and no significant difference between administration of oseltamivir and outcome was observed (P = 0.1512 by Fisher exact test).

[Expression of Aurora-B in human glioma tissue and its significance].

OBJECTIVE: To study the expression of Aurora-B in human glioma tissue and its significance. METHODS: The total RNA was extracted from 41 human glioma tissues and 11 normal brain tissues by Trizol reagent. After reverse transcription of the total RNA into cDNAs, Aurora-B mRNA expressions in these samples were detected by quantitative real-time PCR. The protein expression in these samples was detected using immunohistochemical staining. RESULTS: Aurora-B mRNA and protein expressions were significantly increased in glioma tissues as compared with those in normal brain tissues. CONCLUSION: Aurora-B mRNA and protein show markedly higher expressions in glioma tissue, suggesting that Aurora-B may be one of the malignant biomarkers in the pathogenesis and progression of human glioma.

Invasive pediatric Neisseria meningitidis infections.

BACKGROUND AND PURPOSE: Neisseria meningitidis usually causes severe infection in children, but occurs only sporadically in Taiwan. However, the number of infections increased in 2001 and 2002. This study was performed to ascertain the epidemiology and clinical manifestations of infections caused by meningococcus in a pediatric population. METHODS: The medical charts of patients with meningococcal diseases who were admitted to Chang Gung Children's Hospital, Taoyuan, Taiwan, from July 1998 to December 2005 were retrospectively reviewed. Data were analyzed for age distribution, serogroups, clinical diagnoses, treatment, acute complications, and outcomes. RESULTS: Sixteen children with meningococcal disease were identified. Their ages ranged from 1 month to 15 years (average, 3 years). Most patients (62.5%) were younger than 1 year and the second most frequent age group was 6 to 15 years (18.75%). There were 56.25% boys and 43.75% girls. The identified serogroups were B (43.75%), W135 (31.25%), A (6.25%), Y (6.25%), and undetermined (12.5%). The antibiotics used in this study were ampicillin, ceftriaxone, cefotaxime, and aqueous penicillin; the mean total treatment duration was 10 days. Purpura fulminans (37.5%), disseminated intravascular coagulopathy (31.25%), respiratory failure (25.0%), and shock (25.0%) were the commonest acute complications. Most (87.5%) of the patients survived. One patient had long-term sequelae of hearing impairment and speech delay. The mortality rate was 12.5%. CONCLUSIONS: Serogroup B and W-135 were 2 predominant serogroups to cause pediatric meningococcus, and the majority of infections occurred in children younger than 1 year. Continuous surveillance and prevention of meningococcal infections are of great importance.

Diagnostic significance and management principles of colorectal intraepithelial neoplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the significance of pathological diagnosis of colorectal intraepithelial neoplasia and its treatment principles.</p><p><b>METHODS</b>One hundred and fifty-eight cases with colorectal tumors were treated between January 2004 and June 2008, among them 73 cases of tumors were diagnosed as low grade intraepithelial neoplasia and 89 tumors as high grade intraepithelial neoplasia on biopsy. Five patients with adenoma were treated with endoscopic polypectomy, 49 patients with radical colectomy, 74 patients with low anterior resection (LAR), 16 patients with local excision, 2 patients with Hartmann operation, 4 patients with abdominal perineal resection, 7 patients with Parks coloanal anastomosis and 1 patient with sigmoid colostomy. The postoperative pathological examination result was compared with preoperative biopsy examination.</p><p><b>RESULTS</b>With postoperative pathological examination, 109 cases (67.3%) were identified as infiltrative adenocarcinoma, among them 80 cases (89.9%) had been diagnosed as high grade intraepithelial neoplasia and the other 29 cases (39.7%) had been diagnosed as low grade intraepithelial neoplasia before the operation. In patients with infiltrative adenocarcinomas, 2 cases developed hepatic metastasis, 18 were classified as phase T4, and 26 cases (23.9%) were found with lymph nodes metastasis after the operation.</p><p><b>CONCLUSIONS</b>We should pay more attention to tumors with a diagnosis of intraepithelial neoplasia due to its high potential of malignancy. When the lesion was highly suspected to be malignant, and the resection of the tumor would save the anal sphincter, the tumor should be treated with segmental resection. If the tumor could be confirmed as a infiltrating one then a curative resection is the first choice.</p>

Exploration on neoadjuvant chemoradiation in the treatment for locally advanced low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the possibility of further improvement of the efficacy of neoadjuvant chemoradiotherapy in locally advanced lower rectal cancer and the management of patients with clinical complete regression.</p><p><b>METHODS</b>From May 2001 to August 2007, 192 cases with locally advanced lower rectal cancer (T3/T4 or N(+)) received preoperative radiotherapy 40 - 46 Gy/20 - 23 fractions and concomitant oral capecitabine 625 mg/m(2) bid for 10 weeks prior to surgery. Curative resection with total mesorectal excision (TME) was carried out 6 weeks after the end of radiation.</p><p><b>RESULTS</b>As a result, 117 cases (60.9%) experienced adverse events but only 2 suffered from G3 side effects. Seventeen cases (8.9%) had a clinical complete tumor regression without surgery; 175 patients underwent curative resection, of them 134 cases with low anterior resection (LAR), 32 cases with ultra-low anterior resection with Park's coloanal anastomosis (6 cases with diverting temporary colostomy) and 9 cases with abdominal pelvic resection (APR). Sphincter preservation was achieved in 94.9%. Twenty-four patients (12.5%) got pathological complete response (CR), 17 patients with clinical CR and the overall CR rate was 21.4%. According to the pathological staging post operation: T0N0 41 cases, T2N0 43 cases, T3N0 77 cases, T4N0 5 cases, T2N1 11 cases, T3N1 13 cases, T4N1 2 cases; Graded under Dworak's tumor regression: TRG0 8 patients, TRG1 32 patients, TRG2 28 patients, TRG3 83 patients and TRG4 24 patients, with an overall pathological tumor downstaging in 77.14%. No operative death occurred, 5 patients suffered from rectovaginal fistulas and 4 anastomotic leakages with an overall anastomotic leakage rate of 5.1% (9/175) and all the patients recovered uneventfully after properly managed. All patients were followed up for a median time of 42 months (range, 12 - 87 months). During the time, 11 patients developed lung metastases, 6 liver metastases and 7 had local recurrences. The 3 years disease-free survival (DFS) was 86.6% and overall survival (OS) was 92.6%.</p><p><b>CONCLUSIONS</b>Neoadjuvant chemoradiotherapy has high efficacy in locally advanced lower rectal cancer, resulting in tumor down-staging, improved resectability and sphincter preservation, and reduced local recurrences. Meanwhile the cases with clinical complete response can be followed up closely and safely without surgery.</p>

Effect of neoadjuvant chemoradiotherapy on the healing of anastomosis following low anterior resection in locally advanced rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of the neoadjuvant chemoradiotherapy (NCR) on the healing of anastomosis following low anterior resection in patients with locally advanced rectal cancer.</p><p><b>METHODS</b>Between May 2001 and August 2007, 192 patients with T3 and T4 low rectal cancer (distance from the tumor to anal verge </= 6 cm) enrolled in the study. All patients were subjected to preoperative radiotherapy to pelvis, with a total dose of 40 - 46 Gy in 20 days fractions of 2 Gy each in 4 weeks and simultaneously combined with oral capecitabine (CAP) of 1250 mg/m(2) bid continuously for 10 weeks up to surgery. The patients were operated on 6 weeks after the end of radiotherapy according to the rule of TME technique.</p><p><b>RESULTS</b>All patients fulfilled the study. Of the patients, 17 cases were diagnosed tumor free after the neoadjuvant therapy and were not operated on. Other 24 cases were found got complete tumor response with pathological examination after the operation. A total of 41 cases (21.4%) got complete tumor response with the neoadjuvant therapy. Surgery was performed in 175 patients, and 166 patients (95.3%) with sphincter-saving resection, 134 patients with low anterior resection (LAR, double stapling technique) and 32 patients with Park's endoanal anastomosis. Six patients were operated with abdomino-perineal resection (APR) and 3 patients with Hartmann's procedure. Anastomotic leakage was found in 9 patients (5.1%), 6 patients (4 cases of rectovaginal leakage) with LAR(double stapling technique) and 3 patients (1 case of rectovaginal leakage) with Parks technique (P > 0.05). Anastomotic leakage occurred in 2 - 10 days post operation, and were managed properly and got desirable results.</p><p><b>CONCLUSION</b>Neoadjuvant chemoradiotherapy would not affect the healing of anastomosis obviously if being applied reasonably in locally advanced low rectal cancer.</p>

Clinical and genetic characterization of severe influenza B-associated diseases during an outbreak in Taiwan.

BACKGROUND: Mismatches between circulating and vaccine strains of influenza virus had been observed in Taiwan. A comprehensive clinical and genetic analysis of influenza B viruses-associated important diseases was lacking. OBJECTIVES: Clinical and phylogenetic analysis of influenza B viruses during an outbreak in Taiwan. STUDY DESIGNS: Clinical manifestations of hospitalized, culture-confirmed patients were analyzed from July 2004 to June 2005. Partial genome sequence analysis of hemagglutinin (HA), neuraminidase (NA), and nonstructural (NS) genes were performed in 54 influenza B isolates during the study period, and nine srandomly chosen isolates during 2000 and 2003. RESULTS: Three specific diseases were found in these patients, including 13 of encephalitis/encephalopathy, 28 of influenza-associated myositis (IAM), and one of acute respiratory distress syndrome (ARDS). Three phylogenetic groups were identified, including reassortant strains-group 1 (Victoria lineage of HA, Yamagata lineage of NA, clade A of NS), group 2 (Yamagata lineage of HA, Yamagata lineage of NA, clade A of NS), and group 3 (Yamagata lineage of HA, Yamagata lineage of NA, clade B of NS). CONCLUSIONS: Severe influenza B-associated disease in children was not rare and might be fatal. We offered the evidence of co-circulation of the two HA lineages in the same outbreak.