Emergence of Decapod iridescent virus 1 in cultured shrimp from Taiwan in 2020.

OBJECTIVES: This study was to identify and characterize Decapod iridescent virus 1 (DIV1) in the outbreaks reported in two whiteleg shrimp farms and one black tiger shrimp farm located in northern Taiwan in 2020. METHODS: The histopathology, electron microscopy and polymerase chain reaction (PCR) specific for the DIV1 were used to identify the virus, and the phylogenetic analysis was performed by comparing the major capsid protein gene fragment of DIV1s from Taiwan with reference sequences of the family Iridoviridae. RESULTS: DIV1 was identified by diagnostic PCR and caused mild mortality (20%) in cultured Penaeus monodon and high mortality (100%) in cultured whiteleg shrimp. Cultured P. monodon was first found to be infected with DIV1 through natural route of infection. Histopathological examination showed dark-eosinophilic cytoplasmic inclusions in the degenerative cells of targeted hematopoietic tissues. For electron microscopy, a non-enveloped virus particle was observed from homogenates of mixed target organs through negative staining with a diameter of 112±2 nm. Nucleotide sequences of DIV1 isolates from the Taiwanese outbreak are 100% identical to those from the PRC. CONCLUSIONS: Based on the clinical evidence, mortality rates, histopathology, electron microscopy examinations and phylogenetic analysis, it is believed that DIV1 is the causative agent of the outbreak. This is the first report of DIV1 in cultured shrimp in Taiwan. The emergence of DIV1 signals a warning to shrimp aquaculture farmers worldwide.

Perfluorooctyl bromide nanoemulsions holding MnO2 nanoparticles with dual-modality imaging and glutathione depletion enhanced HIFU-eliciting tumor immunogenic cell death

Tumor-targeted immunotherapy is a remarkable breakthrough, offering the inimitable advantage of specific tumoricidal effects with reduced immune-associated cytotoxicity. However, existing platforms suffer from low efficacy, inability to induce strong immunogenic cell death (ICD), and restrained capacity of transforming immune-deserted tumors into immune-cultivated ones. Here, an innovative platform, perfluorooctyl bromide (PFOB) nanoemulsions holding MnO2 nanoparticles (MBP), was developed to orchestrate cancer immunotherapy, serving as a theranostic nanoagent for MRI/CT dual-modality imaging and advanced ICD. By simultaneously depleting the GSH and eliciting the ICD effect via high-intensity focused ultrasound (HIFU) therapy, the MBP nanomedicine can regulate the tumor immune microenvironment by inducing maturation of dendritic cells (DCs) and facilitating the activation of CD8+ and CD4+ T cells. The synergistic GSH depletion and HIFU ablation also amplify the inhibition of tumor growth and lung metastasis. Together, these findings inaugurate a new strategy of tumor-targeted immunotherapy, realizing a novel therapeutics paradigm with great clinical significance.

Radiation exposure during the treatment of spinal deformities.

AIMS: To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. METHODS: Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). RESULTS: There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. CONCLUSION: The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible. Cite this article: Bone Joint J 2021;103-B(4):1-7.

Effect of chicoric acid on oxidative stress during myocardial injury in sepsis rats and relationship with Nrf2 signaling pathway / 中华麻醉学杂志

Objective:To evaluate the effect of chicoric acid on oxidative stress during myocardial injury in sepsis rats and the relationship with nuclear factor E2-related factor 2 (Nrf2) signaling pathway.Methods:Forty healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 220-250 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), lipopolysaccharide (LPS) group (group LPS), LPS+ chicoric acid group (group LPS+ CA), LPS+ Nrf2 inhibitor ML385 group (group LPS+ ML) and LPS+ chicoric acid+ ML385 group (group LPS+ CA+ ML). LPS 15 mg/kg was intraperitoneally injected to induce sepsis.Immediately after intraperitoneal injection of LPS, chicoric acid 10 mg/kg or ML385 15 mg/kg (in dimethyl sulfoxide) was intraperitoneally injected in group LPS+ CA and group LPS+ ML, respectively, and ML385 15 mg/kg and chicoric acid 10 mg/kg were intraperitoneally injected in LPS+ CA+ ML group.The equal volume of dimethyl sulfoxide was given instead in group C. At 48 h after establishment of the model, blood samples were collected from the aorta for measurement of concentration of serum interleukin-6 (IL-6) and the activities of lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB) (by enzyme-linked immunosorbent assay). The animals were then sacrificed, and myocardial tissues were obtained for microscopic examination of pathological changes (by HE staining), for determination of activities of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) and contents of reactive oxygen species(ROS) and iron (by colorimetry), for calculation of the ratio of oxidized nicotinamide adenine 2 nucleotides to reduced nicotinamide adenine 2 nucleotides (NAD + /NADH), and for detection of the expression of Nrf2, NADPH quinone oxidoreductase 1 (NQO1), glutathione peroxidase 4 (GPX4) and nicotinamide adenine dinucleotide phosphate oxidase 1 (NOX1) (by Western blot). Results:Compared with C group, the activities of serum LDH and CK-MB and concentration of IL-6 were significantly increased, the contents of ROS and iron and the ratio of NAD + /NADH were increased, activities of GSH-Px and SOD were decreased, expression of Nrf2, NQO1 and GPX4 was down-regulated, and NOX1 expression was up-regulated in the other four groups ( P<0.05). Compared with group LPS, the activities of serum LDH and CK-MB and concentration of IL-6 were significantly decreased, the contents of ROS and iron and the ratio of NAD + /NADH were decreased, activities of GSH-Px and SOD were increased, expression of Nrf2, NQO1 and GPX4 was up-regulated, NOX1 expression was down-regulated ( P<0.05), and the pathological changes of cardiomyocytes were significantly reduced in group LPS+ CA, and the activities of serum LDH and CK-MB and concentration of IL-6 were significantly increased, the ratio of NAD + /NADH were increased, activities of GSH-Px and SOD were decreased, expression of Nrf2, NQO1 and GPX4 was down-regulated, NOX1 expression was up-regulated ( P<0.05), and the pathological changes of cardiomyocytes were accentuated in group LPS+ ML.Compared with group LPS+ CA, the activities of serum LDH and CK-MB and concentration of IL-6 were significantly increased, the contents of ROS and iron and the ratio of NAD + /NADH were increased, activities of GSH-Px and SOD were decreased, expression of Nrf2, NQO1 and GPX4 was down-regulated, NOX1 expression was up-regulated ( P<0.05), and the pathological changes of cardiomyocytes were accentuated in group LPS+ CA+ ML. Conclusion:The mechanism by which chicoric acid reduces myocardial injury in sepsis rats may be related to activating Nrf2 signaling pathway and inhibiting oxidative stress.

Development and Validation of a Prognostic NomogramBased on Clinical and CT Features for Adverse OutcomePrediction in Patients with COVID-19

Objective@#The purpose of our study was to investigate the predictive abilities of clinical and computed tomography (CT)features for outcome prediction in patients with coronavirus disease (COVID-19). @*Materials and Methods@#The clinical and CT data of 238 patients with laboratory-confirmed COVID-19 in our two hospitalswere retrospectively analyzed. One hundred sixty-six patients (103 males; age 43.8 ± 12.3 years) were allocated in thetraining cohort and 72 patients (38 males; age 45.1 ± 15.8 years) from another independent hospital were assigned in thevalidation cohort. The primary composite endpoint was admission to an intensive care unit, use of mechanical ventilation, ordeath. Univariate and multivariate Cox proportional hazard analyses were performed to identify independent predictors. Anomogram was constructed based on the combination of clinical and CT features, and its prognostic performance wasexternally tested in the validation group. The predictive value of the combined model was compared with models built on theclinical and radiological attributes alone. @*Results@#Overall, 35 infected patients (21.1%) in the training cohort and 10 patients (13.9%) in the validation cohortexperienced adverse outcomes. Underlying comorbidity (hazard ratio [HR], 3.35; 95% confidence interval [CI], 1.67–6.71;p < 0.001), lymphocyte count (HR, 0.12; 95% CI, 0.04–0.38; p < 0.001) and crazy-paving sign (HR, 2.15; 95% CI, 1.03–4.48;p = 0.042) were the independent factors. The nomogram displayed a concordance index (C-index) of 0.82 (95% CI, 0.76–0.88),and its prognostic value was confirmed in the validation cohort with a C-index of 0.89 (95% CI, 0.82–0.96). The combinedmodel provided the best performance over the clinical or radiological model (p < 0.050). @*Conclusion@#Underlying comorbidity, lymphocyte count and crazy-paving sign were independent predictors of adverseoutcomes. The prognostic nomogram based on the combination of clinical and CT features could be a useful tool for predictingadverse outcomes of patients with COVID-19.

Pre-operative 8 am plasma total cortisol level predicts survival for adrenal cortical carcinoma after surgery / 中华泌尿外科杂志

Objective To investigate the effects of preoperative 8 am plasma total cortisol level (PTC) on the prognosis of adrenocortical carcinoma (ACC).Methods A total of 44 patients from January 2009 to October 2017 with ACC were included,PTC level within one week before surgery,clinical and pathological data were collected.The mean age of the patients was (45.2 ± 15.2) years.There were 27 females and 17 males.The mean tumor diameter was (63.6 ± 20.7) mm.There were 20 cases with functional ACC,in which 18 patients presented symptoms associated with Cushing syndrome.According to ENSAT stage,9 patients were staged as stage Ⅰ,and 35 were staged as stage Ⅱ.The median pre-operative 8 am PTC was 572.6 nmol/L,range from 89.3 to 1 118.7 nmol/L.Open adrenalectomy was employed in 23 patients and laparoscopic approach in 21 patients.The optimal cut-off value of pre-operative PTC was determined by receiver operating characteristic curve (ROC) and patients were divided into two groups with high PTC and low PTC values.Kaplan-Meier method was used to draw the survival curve,univariate and multivariate Cox regression were used to explore factors influencing the prognosis of ACC patients.Results The median follow-up duration was 42 months,range from 3-104 months.The optimal cut-off value was determined as 476.2 nmol/L,baseline and clinic-pathologic characteristics differences between two groups were not statistical significant (P ＞ 0.05).The overall survival (OS) in the high PTC group was shorter than that in the low PTC group [median 18months (20-104 months) vs.40 months (5-98 months),P =0.014],and the recurrence free survival (RFS) of patients in the high PTC group was also shorter than that in the low PTC [median 26 months (0-104 months) vs.50 months (5-98 months),P =0.028).In univariate analysis,age,gender,tumor stage,preoperative PTC,and symptoms were correlated with postoperative OS and RFS (P ＜ 0.05).After adjusting for age,gender,tumor stage,symptoms,multivariate Cox regression showed that pre-operative high PTC was an independent prognostic factor associated with a decreased OS (HR =2.086,95 ％ CI 1.495-2.287,P =0.014) and decreased RFS (HR =2.234,95％ CI 1.546-2.334,P =0.045).Conclusion The preoperative morning PTC is an independent risk factor for the prognosis of ACC.

Observation of mirabilite-bag navel nursing in improvement of gastrointestinal dysfunction in patients after surgery of colon cancer / 中国实用护理杂志

Objective To observe the clinic effects of mirabilite- bag navel nursing in gastrointestinal dysfunction patients after surgery for colon cancer. Methods During Janurary 2013 to Janurary 2016, 80 hospitalized patients with gastrointestinal dysfunction after surgery for colon cancer were randomly allocated to the observation group and the control group, with 40 cases in each group. On the basis of routine nursing, the patients in the control group accepted traditional abdominal bandage nursing, patients in the observation group accepted mirabilite-bag navel nursing. Time to recovery of bowel sound and anal exhaust within 72 hours after surgery, main symptoms within 14 days after surgery such as abdominal pain, abdominal distention, loss of appetite and inflammatory marker C-react protein were observed. Results Within 72 hours after surgery: time to recovery of bowel sound and anal exhaust in the observation group were (26.2±3.3) h and (39.1±8.6) h, respectively, they were significantly shorter than the control group (35.6±6.7) h and ( 65.7±10.9) h, respectively (t=9.42, 11.67, P＜0.01). And there was a higher total effective rate of 90.0% (36/40) in the observation group compared with the total effective rate of 52.5% (21/40) in the control group (χ2=12.14, P＜0.01).Within 14 days after surgery: the total effective rats of improving main symptoms such as abdominal pain, abdominal distention and loss of appetite in the observation group were 90.0%(36/40), 95.0%(38/40), 90.0%(36/40), respectively, all of which were superior to those of the control group, 52.5% (21/40), 40.0% (16/40), 50.0% (20/40), respectively, χ2=12.14, 16.82, 12.75, P＜0.01). Under the nursing interventions, patients′ CRP level in both group were lessened, in the observation group, from (76.91 ± 7.23) mg/L before the intervention to (19.73±5.68)mg/L after the intervention (t=28.43, P<0.05); in the control group, from (77.12±8.09) mg/L before the intervention to (60.33 ± 6.21) mg/L after the intervention (t=6.79, P<0.05). The difference between the two groups also showed statistical significance (t=23.085, P<0.05). Conclusion Mirabilite-bag navel nursing can promote the recovery of gastrointestinal function, lessen inflammatory reaction, improve the main symptoms in patients after surgery of colon cancer.

Evaluation parameters between intra-voxel incoherent motion and diffusion-weighted imaging in grading and differentiating histological subtypes of meningioma: A prospective pilot study.

PURPOSE: To prospectively evaluate the usage of intra-voxel incoherent motion (IVIM) magnetic resonance imaging (MRI) parameters in grading and differentiating histological subtypes of meningiomas and in comparing their ability with the traditional diffusion-weighted imaging (DWI) parameter (apparent diffusion coefficient, ADC). METHODS: In this prospective study, 102 participants underwent IVIM MRI and DWI. Traditional DWI and IVIM MRI were performed by using 2 b values (0, 1000s/mm2) and 12 b values (0-3500s/mm2), respectively. Finally, the values of ADC and IVIM parameters were collected from 72 Grade I and 11 Grade II meningiomas. RESULTS: The mean ADC values of Grade II and Grade I meningiomas were 0.909±0.268×10-3mm2/s and 0.905±0.194×10-3mm2/s, respectively, p=0.967. The D values were lower in Grade II meningiomas than in Grade I meningiomas (0.459±0.072×10-3mm2/s vs. 0.524±0.030×10-3mm2/s, respectively, p=0.005). In ROC curves, the cut-off D value that separated Grade II meningiomas from Grade I meningiomas was 0.479×10-3mm2/s with a sensitivity of 90.9% and a specificity of 76.7%. The secretory and angiomatous meningiomas had higher IVIM parameters than the other subtypes (all p<0.05). D* was significantly lower in fibrous meningiomas than in other meningiomas (2.783±1.179×10-3mm2/s vs. 5.125±1.918×10-3mm2/s, p<0.001). D, rD and rf values correlated negatively with Ki-67 index while D* and rD* value had positive relation with Ki-67 values. CONCLUSION: IVIM MRI is a promising technique for distinguishing different grades of meningiomas. Different subtypes of meningiomas have different IVIM features, which may help to treatment decision and prognosis evaluation.

A clinical comparative study of Keyhole with re-ostomy and without re-ostomy in the treatment of laparoscopic parastomal hernia repair for stoma hernia / 中华普通外科杂志

Objective To compare laparoscopic Keyhole parastomal hernia repair with re-ostomy technique or without re-ostomy in the treatment of stoma hernia,then analyze the advantages of reconstruction ostomy,and summarize the key technical points of the reconstruction operation.Methods From Jan 2010 to Dec 2016,68 stoma hernia patients underwent laparoscopic Keyhole parastomal hernia repair with reostomy technique,52 patients underwent laparoscopic Keyhole parastomal hernia repair without re-ostomy technique.The preoperative,intraoperative and postoperative parameters were analyzed.Results Compared to without re-ostomy group,the re-ostomy reconstruction group had low incidence rate of intestinal fistula (x2 =5.411,P =0.033),patch infection (x2 =6.823,P =0.014),the incidence of postoperative serous swelling and serum swelling (x2 =14.266,P ＜0.001),postoperative recurrence (x2 =8.688,P =0.005) and postoperative appearance dissatisfaction (x2 =9.479,P =0.004).Conclusion Laparoscopic parastomal hernia repair and re-ostomy technique reduces the incidence rate of intestinal fistula,patch infection and serous swelling and serum swelling,decreases the postoperative recurrence rate and appearance dissatisfaction.

Prediction of the consistency of pituitary adenoma: A comparative study on diffusion-weighted imaging and pathological results.

OBJECTIVES: This study aims to evaluate the role of BLADE magnetic resonance (MR) diffusion-weighted imaging (DWI) and other traditional MRI parameters to predict pituitary adenoma consistency in combination with pathological results. METHODS: Thirty-four patients with surgery and pathological diagnosis of pituitary adenomas were included in this study. All exams were performed at 3.0T with traditional MRI sequences and BLADE DWI to acquire MRI parameters, then the consistency and collagen content of pituitary adenomas were evaluated at and after surgery respectively to explore the capacity of MRI technique to predict consistency or its correlation with collagen content. RESULTS: According to consistency evaluated at surgery, 29 pituitary adenomas were categorised as soft while others were regarded as hard. SI ratio of pre- or post-enhanced T1-weighted images, T2-weighted images or ADC values exhibited no significant relationship with adenoma consistency. To some extent, the ADC ratio had diagnostic value to predict hard consistency for ADC<1.077, while the AUC was 0.7724 for the ROC curve. H.E. staining and Masson staining were used to assess collagen content qualitatively and quantitatively. Adenoma consistency was relevant to collagen content while the cut-off value for collagen content between soft and hard tumours was 15.39%; the ADC ratio exhibited close relationship with collagen content, showing a lower ADC ratio for increasing collagen content. CONCLUSIONS: This study revealed that the ADC ratio decreased with increasing collagen content and predicted hard consistency of tumours for ADC<1.077. Correlation between ADC ratio and tumour consistency needs further exploration.

Application of calcineurin inhibitor monotherapy in renal transplantation after alemtuzumab induction:a Meta-analysis / 器官移植

Objective To evaluate the clinical efficacy and safety of immunosuppression of calcineurin inhibitor monotherapy (AiCNIm)after alemtuzumab induction following renal transplantation.Methods Randomized control clinical trials related to application of AiCNIm (AiCNIm group ) and conventional triple regimes (Triple group ) for immunosupression after renal transplantation,published from 1 980 to December 31 201 4,were searched online from PubMed,Embase,Web of Science,Cochrance library and China National Knowledge Infrastructure (CNKI) databases.Meta-analysis was performed by Rev Man 5.2 software.Results Five randomized control studies consisting of 421 renal transplant recipients were included.The results of follow up for 6-1 2 months revealed that compared with the Triple group, the incidence of rejection response confirmed by acute rejection or aspiration biopsy in the AiCNIm group was significantly lower [relative risk (RR) =0.59,95% confidence interval (CI):0.40-0.89 ].However,there was no significant difference in the risk of renal allograft dysfunction (RR =0.85,95%CI:0.38-1 .87),death of recipient (RR =0.89,95%CI:0.30-2.67),infection (RR =1 .03,95%CI:0.91 -1 .1 7)and new-onset diabetes after transplantation (RR =0.62, 95%CI:0.29-1 .30)between two groups (all in P >0.05).Conclusions According to the existing evidence,application of calcineurin inhibitor monotherapy after renal transplantation exerts short-term immunosuppressive effect and high safety after alemtuzumab induction.

Effects of White Mange Mixture on VEGF Content and Genetic and Protein Expressions of VEGFR-2 in Cultured HaCaT Cells / 中国中医药信息杂志

Objective To observe the effects of White Mange Mixture on the content of VEGF and the genetic and protein expressions of VEGFR-2 of HaCaT cells;To explore its mechanism. Methods HaCaT cells were cultured in vitro to establish psoriasis experimental model. SD rats were randomly divided into the blank serum group, white mange mixture of low-, medium- and high- dose groups and acitretin group, meanwhile to set up blank control group. Cultured HaCaT cells model were intervened with different medicine serum. ELISA was applied to detect the content of VEGF. RT-PCR and Western blot were used to detect the genetic and protein expressions of VEGFR-2.Results Compared with the blank control group, White Mange Mixture of low-, medium- and high-dose groups interventing HaCaT cells could obviously inhibit the secretion of VEGF and decrease the genetic and protein expression of VEGFR-2 in a dose-dependent manner. Conclusion White Mange Mixture plays a role in the treatment of psoriasis possibly through inhibiting the content of VEGF and decreasing the genetic and protein expressions of VEGFR-2.

Diffusion-weighted imaging of the sellar region: a comparison study of BLADE and single-shot echo planar imaging sequences.

PURPOSE: The purpose of this study is to compare BLADE diffusion-weighted imaging (DWI) with single-shot echo planar imaging (EPI) DWI on the aspects of feasibility of imaging the sellar region and image quality. METHODS: A total of 3 healthy volunteers and 52 patients with suspected lesions in the sellar region were included in this prospective intra-individual study. All exams were performed at 3.0T with a BLADE DWI sequence and a standard single-shot EP-DWI sequence. Phantom measurements were performed to measure the objective signal-to-noise ratio (SNR). Two radiologists rated the image quality according to the visualisation of the internal carotid arteries, optic chiasm, pituitary stalk, pituitary gland and lesion, and the overall image quality. One radiologist measured lesion sizes for detecting their relationship with the image score. RESULTS: The SNR in BLADE DWI sequence showed no significant difference from the single-shot EPI sequence (P>0.05). All of the assessed regions received higher scores in BLADE DWI images than single-shot EP-DWI.

Reduced dose of Bacillus Calmette-Guérin versus full dose of Bacillus Calmette-Guérin for non-muscle-invasive bladder cancer after transurethral resection bladder tumor: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bladder cancer is widely known as the most common malignant tumor in the urinary tract, with 75%-85% of patients suffering from nonmuscle invasive bladder cancer (NMIBC). However, the optimal dose of Bacillus Calmette-Guérin (BCG) remains controversial. The aim of this study was to compare the therapeutic efficacy of full dose (FD) with the reduced dose (RD) of BCG.</p><p><b>METHODS</b>Randomized controlled trials (RCTs) were selected through the Cochrane Library, PubMed and Embase and were supplemented by hand searching of bibliographies. The end points include overall survival rate, recurrence rate, progression rate and side effects.</p><p><b>RESULTS</b>Five RCTs that included a total of 1 473 patients (727 in the reduced dose group vs 746 in the full dose group), with a median follow-up period from 33.5 month to 7.1 year. Disease in 80 of 687 (11.6%) patients assigned to the RD group progress to the muscular layer or distant metastasis, compared with 81 of 698 (11.6%) patients assigned to the FD group (RR = 1.02; 95% CI, 0.77-1.36; P = 0.89). The incidence of recurrence at three year was reported in all five studies to be 41.1% (299 of 727) and 36.1% (269 of 746) in the RD and FD groups, respectively (RR = 1.13; 95% CI, 1.00-1.29; P = 0.05). The 5-year survival rate was 75.9% (502 of 662) in the RD group, and 75.8% (510 of 673) in the FD group. In the RD group 41 of 655 (6.3%) patients and 56 of 663 (8.7%) patients in the FD group did not complete the treatment due to systemic or local side effects (RR = 0.75; 95% CI, 0.51-1.10; P = 0.14) CONCLUSIONS: In general, the results of our study demonstrate a trend towards a reduction of the toxicity in reduced dose group without affecting the efficacy of treatment when compared with full dose. More trials with large sample size are still necessary to explore the prognosis of the patients with high risk of tumor in different dose group.</p>

Totally laparoscopic management for acute calculous cholangitis / 中华普通外科杂志

Objective To sunmarize the clinical experience of emergency laparoscopic choledocholithotomy plus T-tube drainage for acute calculous cholangitis.Methods We retrospectively analyzed the clinical data of 98 cases with acute calculous cholangitis undergoing emergency laparoscopic choledocholithotomy between Mar 2007 to Jul 2011 at our hospital.Results In this study,93 cases with definite diagnosis of acute calculous cholangitis underwent at their acute stage totally laparoscopic choledocholithotomy and T-tube drainage,2 cases received laparoscopic transeystic common bile duct exploration and 3 cases were treated with primary closure of the common bile duct following laparoscopic common bile duct exploration and intra-bile duct stent.All procedures were successful without conversion to open surgery.The average of the operative time and the hospital stay was 96 minutes and 12 days respectively.The major complications included residual stones in 8 cases,bile leakage in 4 cases and intraperitoneal bleeding in I case.All were cured by conservative therapy.Conclusions For most patients of acute calculous cholangitis,emergency T-tube drainage after laparoscopic chuledocholithotomy is safe and effective.

Clinical outcomes in renal allograft recipients switched to long-term immunosuppressive therapy with mycophenolate mofetil after renal transplantation / 中华器官移植杂志

Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.

Effects of asymptomatic arteriovenous fistula closure on left ventricular morphology and function in renal transplant recipients-a prospective, randomized, controlled study / 中华器官移植杂志

Objective To evaluate the effects of asymptomatic arteriovenous fistula closure on left ventricular morphology and function in renal transplant recipients.Methods Between March 2007 and March 2011,a total of 60 patients undergoing consecutive kidney transplantation with asymptomatic arteriovenous fistula were divided randomly into two groups: arteriovenous fistula closure group,and non-arteriovenous fistula closure group.By using echocardiography,the changes in CO,CI,EF,LVEDV and LVMI were analyzed.Results At 12th month after transplantation,the values of CO,LVEDV and LVMI were significantly lower than those before transplantation (P＜0.05).The value of CI also showed a tendency to decrease (P＞0.05),and the value of EF was increased significantly (P＜0.05).At 6th month after arteriovenous fistula closure (18 months after transplantation),the values of CO,CI,LVEDV and LVMI were significantly lower than those before arteriovenous fistula closure (12 months after transplantation) (P＜0.05),and the value of EF was increased significantly (P＜0.05),but the values of CO,CI,EF,LVEDV and LVMI remained unc(b)anged in controls (P＞0.05).At 18th month after transplantation,the values of CO (4.4 ±0.8 L/min),CI [3.0 ± 0.8 L·min-1·m-2],LVEDV (110.0 ± 17.4 ml) and LVMI (114.7 ± 42.5g/m2) in trial group were significantly lower than the values [CO: 5.1 ± 0.9 L/min,CI: 3.5 ± 1.0L·min-1·m-2,LVEDV: 121.4±19.3 mL,LVMI: 138.4±44.1 g/m2] in controls (P＜0.05),and the value of EF (75.2％ ± 7.4％ vs.70.5％ ± 8.2％) significantly higher (P＜005).Conclusion In both groups,kidney transplantation benefits significantly the regression of cardiac mass,cardiac index and left ventricular dimensions,but closure of asymptomatic AVF induces more significant regression.

Technical difficulties and avoidance of complications in delayed laparoscopic cholecystectomy for acute cholecystitis / 中华肝胆外科杂志

Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).MethodsThe results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.ResultsThere was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P＜0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 ％ vs 2/99 2.02 ％,P＞0.05).ConclusionsDelayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.

Epithelial-mesenchymal transition of renal tubular epithelial cells under anoxia / 中华器官移植杂志

Objective To explore whether anoxia can induce expression changes in connective tissue growth factor(CTGF)in renal tubular epithelial cells(TECs)and epithelial-mesenchymal transition of TECs.Methods Rat renal TECs(NRK-52E)anoxia models were established.NRK-52E cells were exposed to anoxia for 4 h.The real-time RT-PCR,Western blotting,immunohistochemical staining were used to detect the expression of CTGF at 6,12,24,48,and 72 h in NRK-52E cells.Morphological changes and cytoskeleton remodeling in NRK-52E cells under anoxia were examined by a laser confocal microscope and BODIPYFL staining respectively.Results Under anoxia,NRK-52E cells became round,enlarged and cytoskeleton was remodeled.The expression levels of CTGF mRNA and protein were up-regulated at 6 h,reached their peak at 48 h:the expression of CTGF mRNA protein was 29.33±0.21 and 1.30±0.02 respectively.Under anoxia,NRK-52E cells underwent an epithelial-mesenchymal transition process,including cytoskeleton remodeling,and morphological changes.Conclusion Anoxia can change the expression of CTGF and other fibrosis-associated genes in NRK-52E cells,and CTGF played an important role in fibrosis process and epithelial-mesenchymal transition development in NRK-52E cells.