2019, 41 (3): 283-290
ZHANG Xin, SHEN Le, HUANG Yuguang
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Objective To investigate the effects of simvastatin on diabetic neuropathic pain and systematic inflammation in diabetic rats and explore their molecular mechanisms.Methods Totally 24 rats were equally randomized into the normal+vehicle(NV)group,diabetic+vehicle(DV)group,and diabetic+simvastatin(DS)group using the random number table.Streptozotocin(STZ)was used to establish the rat models of diabetes.Blood glucose,body mass,paw withdrawal mechanical threshold(PWMT),and paw withdrawal thermal latency(PWTL)in each group were observed on days 7,14,21,and 28 after STZ injection.On day 28 after STZ injection,rats were sacrificed,and the lumbar spinal dorsal horn and serum were collected.Western blotting was used to detect the expression of receptor for advanced glycation end products(RAGE)and the phosphorylation levels of protein kinase B(AKT),extracellular signal-regulated kinase(ERK),p38,and c-Jun N-terminal kinase(JNK)in the spinal dorsal horn of rats in each group.Enzyme-linked immunosorbent assay was performed to determine the serum concentrations of oxidized low density lipoprotein(ox-LDL)and interleukin-1β(IL-1β).Results On days 14,21 and 28 after STZ injection,the PWMT in DV group were(8.6 ± 0.8),(7.1 ± 1.6),and(7.8 ± 0.8)g respectively,which were significantly lower than (12.0 ± 0.9)(q=8.482,P =0.000),(11.6 ± 1.5)(q=11.309,P =0.000),and(11.7 ± 1.5)g(q=9.801,P =0.000)in NV group.The PWMT in DS group on days 21 and 28 were(9.4 ± 1.4)(q=5.780,P =0.000)and(9.7 ± 0.9)g(q=4.775,P =0.003),respectively,which were significantly improved comparing with those of DV group.On days 7,14,21,and 28,there were no significant differences in PWTL among these three groups (all P<0.05).The expression of RAGE in the spinal dorsal horn of DV group was significantly higher than those of NV group(q=6.299,P =0.000)and DS group(q=2.891,P =0.025).The phosphorylation level of AKT in the spinal dorsal horn of DV group was significantly higher than those of NV group(q=8.915,P=0.000)and DS group(q=4.103,P=0.003).The phosphorylation levels of ERK(q =8.313,P=0.000),p38(q =2.965,P =0.022),and JNK(q=7.459,P =0.000)in the spinal dorsal horn of DV group were significantly higher than those of NV group;the phosphorylation level of JNK in the spinal dorsal horn of DS group was significant lower than that of DV group(q=3.866,P =0.004);however,there were no significant differences in the phosphorylation levels of ERK(q=1.987,P=0.122)and p38(q=1.260,P=0.375)in the spinal dorsal horn between DS group and DV group.The serum concentrations of ox-LDL and IL-1β in DV group were(41.86 ± 13.40)ng/ml and(108.16 ± 25.88)pg/ml,respectively,which were significantly higher than those in NV group [(24.66 ± 7.87)ng/ml(q=3.606,P=0.003)and(49.32 ± 28.35)pg/ml(q=5.079,P=0.000)] and DS group [(18.81 ± 5.62)ng/ml (q=4.833,P =0.000)and(32.73 ± 11.73)pg/ml(q=6.510,P =0.000)].Conclusions Simvastatin can relieve the mechanical allodynia of diabetic rats possibly by inhibiting the activation of RAGE/AKT and the phosphorylation of JNK in the spinal dorsal horn.Simvastatin can also decrease the serum concentrations of ox-LDL and IL-1β in diabetic rats,which may contribute to the relief of systematic inflammation.
2019, 41 (3): 291-299
ZHANG Jianye, GUAN Yong, KONG Feng, ZHAO Shengtian
Objective To induce adipose-derived stem cells (ADSCs) to differentiate into intermediate mesoderm (IM)-like cells in vitro,with IM-like cells for recellularizing kidney scaffolds,and then to obtain a tissue-engineering kidney with renal structures and functions through co-culture.Methods After inguinal fat pads of Wistar rats were surgically harvested,the primary ADSCs were isolated,induced,and cultured for stem cell identification. ADSCs were inducted to differentiate into IM-like cells by adding glycogen synthase kinase-3 inhibitor (CHIR99021) and fibroblast growth factor 9 (FGF9) at different stages. Seven days later,the IM-like cells were identified. The induced IM-like cells and well-prepared kidney decellularized scaffolds were co-cultured for 10 days to obtain recellularized tissue-engineered kidneys and their differentiation was identified.Results The ADSCs harvested had osteogenic and adipogenic abilities and could express the stem cell surface markers. After 7 days of in vitro induction,the positive expressions of odd-skipped related 1 and paired-box 2 were observed in IM-like cells by immunofluorescence technique. After 10 days of co-culture with kidney decellularized scaffolds,the positive expressions of Wilms’tumor 1,GATA-binding protein-3,and E-cadherin were observed by immunofluorescence technique.Conclusion ADSCs can be induced into IM-like cells,and renal cell differentiation can be observed through combining the induced IM-like cells with kidney decellularized scaffolds.
2019, 41 (3): 300-306
XU Xiaonan, WANG Menglin, ZHANG Ding
Objective To investigate the effects of different inflammatory factors on hepatocyte kinase receptor(Eph)and ligand(ephrin)in human periodontal ligament fibroblasts(hPDLFs).Methods hPDLFs were stimulated with either 10 ng/ml tumor necrosis factor-α(TNF-α)or 10 ng/ml interleukin(IL)-1β,and then the expressions of Eph and ephrin at both mRNA and protein levels were determined at 0,1,2,6,12,and 24 hours.Results The levels of Eph receptors and ephrin ligand changed in a time-dependent manner in human periodontal ligament fibroblasts after treatment with TNF-α or IL-1β. The expression of ephrinA2 significantly increased in both groups within 24 hours(all P<0.05). In the TNF-α group,the mRNA expression of ephrinA2 significantly increased at 1 h and was significant higher that in the IL-1β group at 24 h(P<0.05). EphB4 showed a time-dependent decline after a short period of high expression.Conclusions Both TNF-α and IL-1β can cause changes in the expressions of Eph receptors and ephrin ligands in hPDLFs. The changes induced by both are consistent,although the effect of TNF-α is more pronounced.
2019, 41 (3): 307-314
DONG Hui, LI Xuanhao, CHANG Jinglin, HE Xin, HOU Qinlian, LONG Wei
Objective To describe the microbiological characteristics of Bacillus subtilis(B. subtilis)CGMCC 12426 and determine and analyze its complete genome sequences.Methods B. subtilis strain CGMCC 12426 genomic DNA sequencing was performed on a single molecule real-time sequencing(SMRT)platform and the annotation was completed in the NCBI Prokaryotic Genomic Annotation Pipeline(pGAP).Results The complete genomic sequences of the released B. subtilis CGMCC 12426 consisted of a 4 138 265-bp circular chromosome and a 74 165-bp plasmid,which resulted in the prediction of 4581 genes including 4222 coding sequences,87 tRNAs,and 30 rRNAs(which included 5S rRNA,16S rRNA,and 23S rRNA).Conclusion The genome sequencing provided a basis for further investigations on the genetic background of B. subtilis and on the metabolic and regulatory mechanisms.
2019, 41 (3): 315-322
CHEN Jiangbo,XU Guoshuai,CAI Xiangjun,LIU Hongtao,SUN Kaili,LUO Xue
Objective To explore the expressions of Sry-related high mobility group box 9(SOX9)and gastrokine-1(GKN1) in gastric cancer tissues and their relationships with clinicopathologic features and prognosis of patients.Methods Immunohistochemistry was used to detect the expressions of SOX9 and GKN1 in 70 cases of gastric cancer tissues and corresponding paracancerous tissues including 27 cases of intestinal metaplasia and 43 cases of normal gastric mucosa. The relationships of SOX9 and GKN1 expressions with clinicopathological features and prognosis were analyzed in gastric cancer tissues.Results The high expression rates of SOX9 in gastric cancer tissues,intestinal metaplasia,and normal gastric mucosa were 92.9%(65/70),77.8%(21/27),and 55.8%(24/43),respectively(χ 2=21.722,P<0.001). Positive nuclear and cytoplasmic staining was observed. The high nuclear expression rate of SOX9 in gastric cancer tissues was 67.1%,which was significantly higher than those of intestinal metaplasia(37.0%,P=0.007)and normal gastric mucosa(23.3%,P<0.001). The high cytoplasmic expression rate of GKN1 in normal gastric mucosa was 76.7%,which was significantly higher than those of intestinal metaplasia(44.4%,P=0.006)and gastric cancer tissues(37.1%,P<0.001). Univariate analysis demonstrated that the nuclear expression of SOX9 in gastric cancer was associated with the degree of tissue differentiation(P=0.007),while the cytoplasmic expression of GKN1 was associated with both the degree of tissue differentiation(P=0.002)and whether the pathological type was a signet-ring cell carcinoma(P=0.009). Furthermore,the nuclear expression of SOX9 was negatively correlated with the expression of GKN1 in gastric cancer(χ 2=15.424,P<0.001). The 5-year survival rates of patients with high or low nuclear expression of SOX9 were 33.8% and 67.5%,respectively(P=0.016).The 5-year survival rates of patients with high or low expression of GKN1 were 60.0% and 35.6%,respectively(P=0.044). Further research indicated that 5-year survival rate of patients with high nuclear expression of SOX9 and low expression of GKN1 was 28.8%. Cox multivariate regression analysis showed that TNM stage(stage Ⅱ:HR=7.435,95%CI:1.313-42.096,P=0.023;stage Ⅲ:HR=12.214,95%CI:2.677-55.721,P=0.001)and nuclear expression level of SOX9(HR=3.297,95%CI:1.199-9.065,P=0.021)were independent risk factors for the prognosis of gastric cancer patients.Conclusions Changes in the expressions of SOX9 and GKN1 may be associated with the malignant biological behavior of gastric cancer. SOX9 may be a potential prognostic factor. The combined detection of SOX9 and GKN1 expression and the further study of their molecular mechanism may provide new clues for early diagnosis,targeted therapy,and prognostic prediction of gastric cancer.
2019, 41 (3): 323-330
YU Shuangbin,YU Menglu,CHEN Xi,SUN Yuanyuan,ZHANG Xuan,HOU Furang,YAN Liuqing,GAO Yuyang,YUAN Ping
Objective To understand the prevalence and metabolic abnormalities of fatty liver disease among adults in Mianyang City,Sichuan Province,and to analyze their influencing factors.Methods Totally 294 603 adults aged 18 years and older were enrolled by using a multi-stage stratified random sampling method in Mianyang City from November 1,2014 to September 30,2015.Fatty liver was diagnosed by abdominal ultrasound.The general demographic characteristics,smoking history,drinking history,and history of chronic disease were collected through questionnaires.Meanwhile,10 217 subjects were randomly selected for biochemical tests[fasting plasma gluose(FPG),triacylglycerol(TG),total cholesterol(TC),and alanine aminotransferase(ALT)].Results Of these 294 603 subjects,17 105(5.81%)had fatty liver.After having been age-adjusted based on the results of the sixth national census in 2010,the standardized prevalence was 5.32%.The prevalence was significantly higher in males(6.76%;standardized prevalence:7.24%)than in females(5.09%;standardized prevalence:4.08%)(χ 2=365.814,P<0.001)。The prevalence of fatty liver disease was significantly higher in people with current smokers(8.52%)/ex-smokers(8.89%),occasional alcohol users(6.79%)/regular alcohol users(10.51%)/daily alcohol users(10.62%),and patients with hypertension(12.14%)/diabetes(15.19%)/coronary heart disease(10.22%)than those without corresponding characteristics(all P<0.001).Abnormal increase in body mass index,diastolic blood pressure,FPG,TG,TC,and ALT were risk factors for fatty liver in Logistic regression model.Conclusions The prevalence of fatty liver in adults is relatively low in Mianyang City.Patients with fatty liver usually have varying degrees of abnormal increase in blood lipids,blood glucose,blood pressure,and ALT.Healthy lifestyles and comprehensively assessment of metabolic status are conducive to the prevention and treatment of fatty liver and extrahepatic complications.
2019, 41 (3): 331-337
ZHANG Haiyin,ZHONG Hua,LIN Yuanyuan,ZENG Xianwei,XU Li,FENG Guohua,WEI Yujun,YANG Jianzhong
Objective To investigate the health care-seeking behaviors of Mosuo and Pumi people.Methods The subjects were enrolled by using the multi-stage stratified random sampling method and surveyed by the self-designed questionnaire.Results To tally 1669 subjects including 1121 Mosuo people and 548 Pumi people completed the survey.When Mosuo and Pumi people suffer from ailments,they preferred to buy drugs in drugstores(47.3% for Mosuo and 46.9% for Pumi),followed by visiting a local township hospital(27.0% for Mosuo and 24.3% for Pumi).When they suffered from severe diseases,they preferred to visit the county/city/state hospital(93.4% for Mosuo and 91.1% for Pumi).The mental disease were mainly treated in the county/city/state hospitals(49.3% for Mosuo and 52.7% for Pumi);notably,39.3% of the Mosuo respondents and 31.5% of the Pumi respondents skipped this question.Conclusion Health education,including awareness-raising activities on mental health,should be enhanced in Mosuo and Pumi people to further improve their health care-seeking behaviors.
2019, 41 (3): 338-343
LIU Xiaoyan,LIU Liqun,ZOU Xiaonong,MA Xiangyun,NING Bofu,NING Youfei,WAN Xia
Objective To describe the trend of lung cancer mortality in Xuanwei City,Yunnan Province,from 1990 to 2016 and provide scientific evidence for the prevention and control of lung cancer in Xuanwei.Methods Mortality data from the 2nd(year 1990-1992)and 3rd(year 2004-2005)Retrospective Survey on Causes of Death,and the Routine Death Registration System(year 2011-2013 and 2014-2016)in Xuanwei were used in this study.We calibrated the missing report of the mortality data for the corresponding periods,calculated the crude mortality rates,standardized mortality rates and corresponding 95% CI of different types of lung cancers in the above four periods.Results The crude mortality rates of all lung cancers in Xuanwei for these four periods(1990-1992,2004-2005,2011-2013,and 2014-2016)were 34.0/100 000,89.8/100 000,102.3/100 000 and 87.2/100 000 respectively.The standardized morality rate of lung cancer remain high in Xuanwei although it has been decreasing since 2004.Morality rates of lung cancer for most age groups showed decreasing trends.The decrease has been statistically significant in the ≤ 40 year group since 2014.Except for Longchang,the standardized mortality rates have decreased in all other townships with high lung cancer prevalence.Conclusions Although the mortality rate of lung cancer remains high in Xuanwei,it has shown a decreasing trend since 2004.The decrease in lung cancer mortality in populations younger than 40 years is statistically significant.
2019, 41 (3): 344-350
DONG Liling,GUAN Hongzhi,HUANG Yan,HAO Honglin,NIU Jingwen,LIU Qing,LU Qiang,XU Dan,ZHANG Junyi,ZHOU Lixin,JIN Liri,REN Haitao,ZHU Yicheng,PENG Bin,CUI Liying,ZHOU Xiangqin
Objective To explore the clinical characteristics of autoimmune disease with dual seropositive antibodies of leucine-rich glioma inactivated 1(LGI1)and contactin-associated protein 2(Caspr2).Methods The clinical data of seven patients with dual seropositive LGI1 and Caspr2 antibodies who were admitted to the Neurology Department of Peking Union Medical College Hospital from July 2014 to December 2017 were retrospectively analyzed.Results Central,peripheral and autonomic nervous systems were all involved in the seven cases;100%(7/7)presented with insomnia,myokymia,neuropahic pain and hyperhydrosis;71%(5/7)showed memory decline or psychiatric and behavioral symptoms;57%(4/7)had urinary hesitation or constipation;and 43%(3/7)had seizure.Electromyography showed 100%(6/6) of the patients had prolonged afterdischarges following normal M waves and/or abnormal spontaneous firing.Electroencephalography revealed slow waves or basic rhythm slowing in 71%(5/7)of patients.Electrocardiography showed sinus tachycardia,axis deviation,and prolonged QT intervals in 71%(5/7)of patients.One patient died from arrhythmia before immunotherapy.One died from pulmonary infection after immunotherapy.Improvement with immunotherapy was documented in the other five cases.No relapse was noted during the 1-2-year follow-up.Conclusions Autoimmune disease with dual seropositive antibodies of LGI1 and Caspr2 can diffusely affect the central,peripheral,and autonomic nervous systems.The possibility of this disease should be considered in patients with acute and subacute onset of neuropsychiatric symptoms,especially in patients with accompanying insomnia,myokymia,and hyperhydrosis.
2019, 41 (3): 351-358
ZHANG Zimu,LI Zijian,KANG Weiming,YU Jianchun,YE Xin,MA Zhiqiang,ZENG Ziyang,SUN Juan
Objective To explore the clinical factors that can be used to predict the early weight loss after laparoscopic sleeve gastrectomy(LSG).Methods The clinical data of 64 obese patients undergoing LSG in Peking Union Medical College Hospital from August 2015 to January 2018 were retrospectively analyzed.We analyzed the relationship between different clinical factors and early weight loss,determined the independent predictors based on Logistic models,and estimated their test power by using the receiver operating characteristic(ROC)curves.Results Correlation analysis indicated that preoperative body mass index(P=0.000,P=0.000,P=0.000),waist circumference(WC)(P=0.000,P=0.000,P=0.000),whole body fat volume(P=0.000,P=0.006,P=0.003),homeostatic model assessment for insulin resistance(HOMA-IR)(P=0.000,P=0.000,P=0.002),and hypersensitive C-reactive protein(hsCRP)(P=0.004,P=0.002,P=0.025)were negatively correlated with excess weight loss percentage(EWL %) after 3,6 and 12 months.Also,hsCRP after 6 months showed negative correlation with EWL % after 1 year(P=0.029).Binary Logistic regression analysis showed that WC was an independent predictor of early weight loss(P=0.018).ROC analysis showed that when the optimal cutoff value is 142.5 cm for WC,Youden index was highest,with a sensitivity of 80% and a specificity of 87%.Patients were further divided into low WC group and high WC group based on this optimal cutoff value.The low WC group had significantly higher EWL% than the high WC group 3 months(t=6.677,P=0.000),6 months(t=6.157,P=0.000),and 1 year(t=4.006,P=0.000)after surgery.The low WC group also had significantly lower hsCRP than high WC group 6 months after surgery(z=-3.510,P=0.000).HOMA-IR showed no significant difference between these two groups(z=-0.821,P=0.412).Conclusions WC is an independent predictor of weight loss early after LSG.The patients with low WC have better weight loss effectiveness.
2019, 41 (3): 359-366
YUAN Mingzhen,ZHOU Huiying,CHEN Youxin
Objective To observe the imaging features of optical coherence tomography angiography(OCTA)in eyes with wet age-related macular degeneration(wAMD)after treatment with 3+pro re nata(3+PRN)of intravitreal anti-Ranibizumab.Methods This study included 8 treatment-naive eyes with wAMD diagnosed by fluorescein fundus angiography(FFA)and indocyanine green angiography(ICGA)from September 2016 to May 2017.All the patients were treated with 3+PRN of intravitreal anti-Ranibizumab(0.5 mg/0.05 ml).We performed OCTA with 6 mm×6 mm scans at baseline and 1,3,and 6 months after treatment.We analyzed best corrected visual acuity(BCVA)(logMAR),type of choroidal neovascular(CNV),and morphological features and changes of CNV,central retinal thickness(CRT),outer retina vessel density(ORVD),and choroidal capillary vessel density(CCVD).Results A total of 8 eyes were examined in 8 patients[4 males and 4 females with a mean age of(70.9±10.6)years of age].Three eyes had type Ⅰ CNV and 5 eyes had type Ⅱ CNV.At baseline,month 1,month 3,and month 6,BCVA was 0.55(0.33,0.87),0.35(0.24,0.84),0.35(0.22,0.58),and 0.26(0.10,0.58)logMAR,respectively(all P>0.05).CRT was(271.88±91.95),(204.00±45.78),(196.00±31.14),and(219.25±71.32)μm,respectively,and there was a statistical significance between CRT at baseline and CRT at month 3(t=2.211,P=0.044).ORVD was(41.38±2.77)%,(41.73±3.60)%,(42.53±1.95)%,and(41.40±2.33)%,respectively(all P>0.05).CCVD was(64.38±2.24)%,(64.96±1.39)%,(64.16±1.39)%,and(64.63±1.86)%,respectively(all P>0.05).Correlation analysis showed BCVA was significantly correlated with both CRT(P=0.009, RR=0.457)and CCVD(P=0.001,RR=0.574),but not with ORVD(P=0.093,RR=0.302).The morphological features at baseline showed that 2 eyes were lump-like,2 eyes were line-like,2 eyes were tangles,1 eye was elliptical ring-like,and 1 eye was fragment.At month 1,the morphologies were improved in 7 eyes,including the CNV showed decreased maximum diameter,rupture/fragment,loss of peripheral capillaries,decreased numbers and density,and reduced maximum cross-sectional area;the condition became worse in 1 eye,including the CNV showed ring formation,increased density,and increased maximum diameter.At month 3,the morphologied of 7 eyes were improved,while no obvious change was seen in 1 eye.At month 6,the CNV became normalized in 5 eyes but worsened in 3 eyes.No intraocular infection or other intravitreal injection-related complication was observed during the follow-up.Conclusion Observing CNV characteristics using OCTA technology can be used to evaluate the efficacy of Ranibizumab in patients with wAMD and guide the treatment and follow-up of wAMD patients.
2019, 41 (3): 367-372
LIU Tong,CHEN Danhong,JIA Qunmei,ZHAO Shan,ZUO Lingyan,HUANG Baoyan,CHEN Limeng
Objective To describe the status of hope,self-efficacy,and self-management in patients with chronic kidney disease(CKD)(stages 1-3)and to explore the interactions between these three variables.Methods Herth Hope Index,self-efficacy scale,and CKD self-management instrument were used to evaluate the patients with CKD(stages 1-3)in PUMC Hospital(n=153). Structural equation modeling was used to establish the structural equation model of hope,self-efficacy,and self-management.Results The median score of hope was 40.0(36.0,44.5),and 85.0% of patients were in higher level of hope. The median score of self-efficacy was 8.3(7.1,9.4)and the overall score of self-management was 89.0±13.4. There were no significant differences in level of hope and self-management among patients with different age,gender,marital status,educational level,course of disease,and CKD stages(all P>0.05). Age and marriage status were significantly associated with self-efficacy. Self-efficacy was significantly higher in >65 years group than in other age groups(P<0.05)and was significantly higher in married group than in single group(P<0.05).The level of hope had direct effect on self-efficacy(β=0.67,P<0.05)and self-management(β=0.46,P<0.05).Conclusions The levels of hope,self-efficacy,and self-management are high in patients with CKD(stages 1-3). Hope directly affects the self-efficacy and self-management of these patients.
2019, 41 (3): 373-378
TAN Xiaolu,CHEN Yayu,HU Bo,ZHOU Qiaomei,SHAO Weidong,XU Bo,XIAO Haiping,ZHANG Xing’an
Objective To investigate the 50% effective dose(ED50)and 95% effective dose(ED95)of dexmedetomidine(DEX)combined with 0.032 μg/(kg·h)sufentanil as well as its analgesic effect for patient-controlled intravenous analgesia(PCIA)after video-assisted thoracoscopic surgery(VATS).Methods Totally 25 patients undergoing elective VATS were enrolled. DEX and 0.032 μg/(kg·h)sufentanil were used for postoperative PCIA. The loading dose of DEX was 0.048 μg/(kg·h),and the dose difference between two adjacent patients was 0.008 μg/(kg·h). The DEX dose of a current patient was determined by whether the previous patient was satisfied with postoperative analgesic effect. If the previous patient was satisfied with postoperative analgesic effect,the DEX dose of the current patient was decreased by 0.008 μg/(kg·h);and if the previous analgestic effect was not satisfactory,DEX dose of the current patient was increased by 0.008 μg/(kg·h). The study endpoint was dexmedetomidine dose was<0.008 μg/(kg· h) within 7 upper and lower cycles in 7 consecutive cases. Finally,the probability unit regression was used to estimate the ED50 and ED95 of DEX and their 95% CI.Results When DEX combined with 0.032 μg/(kg·h) sufentanil was used for postoperative PCIA in young patients undergoing VATS,the ED50 and ED95of DEX were 0.0346 μg/(kg· h)[95%CI:0.0283-0.0408 μg/(kg·h)] and 0.0459 μg/(kg·h)[95%CI:0.0400-0.0880 μg/(kg·h)],respectively. No adverse reaction such as vomiting,respiratory depression,or bradycardia occurred. The average Visual Analogue Scale(VAS)scores at rest(Z=-5.128,P=0.000)and cough(Z=-6.642,P=0.000)and the Ramsay sedation score(Z=-2.335,P=0.020)within 6 hours after surgery were higher than those after 6 hour.Conclusion DEX combined with 0.032 μg/(kg·h) sufentanil are effective for postoperative PCIA in patients undergoing VATS when the ED50 and ED95 are 0.0346 μg/(kg·h)and 0.0459 μg/(kg·h),respectively.
2019, 41 (3): 379-382
WANG Lei,SUI Jinghu,DENG Xiaoming,XU Wenli,CHEN Keyu,WEI Lingxin,YANG Dong
Objective To compare the impacts of different nostril on nasotracheal intubation with video laryngoscopy.Methods Totally 120 ASA grade I maxillofacial surgery patients were equally randomized into two groups:group A(left nostril)and group B(right nostril).After rapid induction of anesthesia,the nasal intubation was completed by Tosight video laryngoscope,and the success rate of the first attempt of the tube passing through the nasal cavity was recorded and compared between these two groups.In addition,time of tube through nasal cavity,time of glottis exposure,total intubation time,intubation success rate,and nasal bleeding were recorded.Results The success rate of the first attempt of tube passing through the nasal cavity was not significantly different between groups A and B(84.7% vs. 81.7%;χ 2=0.202,P=0.653).The time of tube passing through nasal cavity [(7.3±4.6)s vs.(7.5±4.1)s;t=-0.223,P=0.824] and the time of glottic exposure [(6.6±1.4)s vs.(6.7±1.4)s;t=-0.348,P=0.728] had no significant differences between two groups.The success rates of first intubation attempt were 100% in both groups.The total intubation time was(35.1±9.2)s in group A and(34.0±7.8)s in group B(t=0.663,P=0.509).Intubation-related epistaxis was found in 16 cases(27.1%)in group A and in 17 cases(28.3%)in group B(χ 2 =0.022,P=0.882).Conclusion Different nasal approaches have no effect on nasal intubation.
2019, 41 (3): 383-387
ZHANG Yan,LUO Yukun,YANG Ming,ZHANG Ying,LI Junlai,TANG Jie
Objective To compare the values of elasticity imaging(EI)and Virtual Touch TM tissue imaging and quantification(VTIQ)in diagnosing thyroid nodules and explore the factors influencing the accuracy of these two techniques.Methods Totally 62 patients who were planned to receive surgery for thyroid nodules underwent conventional ultrasound,EI,and VTIQ examinations.EI patterns were scored according to the degree and distribution of strain,the strain of nodule and surrounding normal reference tissue were measured,and then strain index was calculated.Shear wave velocity in nodules were obtained under VTIQ mode.Results The nodules were malignant in 40 patients and benign in 22 patients.When the strain score of 3 was regarded as malignant,the diagnostic sensitivity,specificity,and accuracy of EI in detecting thyroid nodules were 90.00%,31.82%,and 69.32%,respectively.Receiver operating characteristic curve results showed that the area under curves of EI-SI and VTIQ methods for diagnosing thyroid nodules was 77.8%(95%CI:0.64-0.91)(P=0.000)and 74.3%(95%CI:0.62-0.87)(P=0.002),respectively.Thyroid nodules’ characteristics location(P=0.04)and size(P=0.02)were correlated with the diagnostic accuracy of EI.The accuracy of SI and VTIQ were not affected by thyroid nodules’ characteristics(P>0.05).Conclusions The diagnostic accuracy of EI for thyroid nodules is related to nodules’ characteristics.EI combined with semi-quantitative SI and quantitative VTIQ can effectively improve the diagnostic capability for thyroid nodules.
2019, 41 (3): 388-395
ZHEN Hongnan,MIAO Zheng,LIAN Xin,HU Ke,SHEN Jing,MA Jiabin,GUAN Hui,ZHANG Fuquan
Objective To investigate the demand for scientific information among cervical cancer patients and to evaluate the quality of the relevant information available for these patients.Methods The demand for medical science information among patients with cervical cancer was investigated via questionnaire.The Discernn scoring system was used to score the cervical cancer science articles retrieved by Baidu and Sogou.A model was established to analyse the reading difficulty of these articles.Results Nearly half(53.6%)of the respondents searched for online science information at least weekly.The main target readings were the etiology and risk factors of diseases,symptoms,treatment options,adverse reactions of treatments,and prognosis.Most respondents(96.4%)thought that the network science information was reliable.Of the 104 search results included in the sample bank,13(12.5%)met the inclusion criteria,91(87.5%)were not selected,including 32 duplicates(30.8%),6 non-text webpages(5.8%),18 short texts(less than 300 Chinese characters)(17.3%),7 advertisements(6.7%),3 news articles(2.9%),22 forum posts(21.2%),and 3 academic articles(2.9%).According to the Discern scoring system,the reliability(r=0.728, P<0.001),the quality of treatment-related information(r=0.431, P<0.001),and the overall scores(r=0.559,P<0.001)of the enrolled 13 publications were consistent,as evaluated by two professional physicians.The mean overall score was 3.A lower score(less than 3)in the reliability assessment was due to the source of the content,generation methods,sponsors,citations,and the undefined parts.During the evaluation of treatment information,the average score was below 3 for each item.Analysis of the reading difficulty showed that,among these 13 articles,4 were at postgraduate thesis level(level 5),4 at undergraduate thesis level(level 4),0 at high school textbook level(level 3),and 8 was higher than middle school level(≥level 3).Eight articles(61.5%)were suitable for readers with an education background of higher middle school and only 5 articles(38.5%)were suitable for readers with an education background of middle school or lower(≤ level 2).Conclusions The vast majority of patients with cervical cancer search for clinical information through the Internet and trust their reliability.Chinese search engines have lower detection rates for high-quality medical science articles.The currently available high-quality medical science articles are small in number and difficult to read.More physicians are urged to write easy-to-read high-quality articles for these patients.
Standards and Guidelines
2019, 41 (3): 396-401
YANG Yuan,QIN Yi,CHI Hui,LI Aihua,LI Yongjie,CUI Chunshun,LI Yang
Human genetic resources are valuable for life science research and pharmaceutical industry.Competitions for human genetic resources and the relevant techniques and industries have increasingly become intense among countries with the the implementation of precision medicine strategy and the maturity of gene editing technology.In the context of scientific progress and efficiency,the Organisation for Economic Co-operation and Development,the most important international economic organization,has proposed solutions to technological development and research paradigm changes from the perspective of national and global public interests.The United States,Japan,the United Kingdom,and some other developed countries have also released their policies and guidelines on the sharing of genetic resource data.In this article we analyzed these policies and guidelines,with an attempt to further improve the administration of human genetic resource sharing in China and promote the legal sharing and effective use of these resources.
2019, 41 (3): 402-407
WU Yajun,YAN Li,HU Yuxiang,RAO Jie,XU Xiaoxuan,CHENG Yi,WU Na,WU Xiaorong
Ocular myasthenia gravis(OMG)is an autoimmune disease caused by neuromuscular junction transmission disorders and manifested mainly as fluctuating blepharoptosis and diplopia,with the extraocular muscles as the main involveed sites.While the pathogenesis of OMG remains unclear,some antibodies,complements,and cytokines may be the contributing factors.The diagnosis and treatment of OMG have been defined in recent years.This article reviews the pathogenesis,diagnosis,and treatment of OMG.
2019, 41 (3): 408-414
TU Haoyan,LEI Xiaocan,HUO Peng,LE Jianghua,ZHANG Shun
The growth and development of follicles are regulated by genes,hormones and growth factors autocrined and paracrined from granulosa cells,theca cells,and oocytes.Products of glycolysis from granulosa cells such as pyruvate and lactate are one of the main energy sources,which play an important role during folliculogenesis and follicle maturity.Studies on the changes of the products and rate-limiting enzymes during granulosa cells’ glycolysis help to clarify the molecular mechanism of energy demand in folliculogenesis and guide the clinical treatment of infertility due to abnormal follicular development.This article reviews recent research advances in the energy demand and regulatory mechanism in different states of folliculogenesis.
2019, 41 (3): 415-418
TANG Hongyan,XIAO Bin,WANG Liping,YANG Guilan
Insulin-like growth factors(IGFs)are polypeptides structurally homologous to insulin.By binding to membrane tyrosine receptors,they regulate the proliferation,differentiation,apoptosis,growth,and development of body cells and are involved in the pathogenesis of tumors and other diseases.In recent years,more research on IGFs of dermatosis increased.This article reviews recent research advances in IGFs and its relationship with dermatosis.
2019, 41 (3): 419-424
REN Yanping,LIU Qiongyou,LEI Xiaocan
The chromosomal aneuploidy in oocytes is one of main causes of abortion and neonatal birth defects.It is mainly due to the premature separation of sister chromatid caused by the loss of Cohesin protein complex and the non-disjunction sister chromatids caused by abnormal microtubule dynamics aneuploidy.As a pathway of protein post-translational modification,SUMO modification(or SUMOylation)involves many physiological regulation processes including cell proliferation,differentiation,apoptosis,and cycle regulation.In the oocytes,SUMOylation can regulate the localization of Cohesin protein complex on the chromosome to affect the chromosomal aneuploidy in oocytes caused by premature separation of sister chromatid.On the other hand,SUMOylation can regulate the microtubule dynamics to affect the chromosomal aneuploidy in oocytes caused by non-disjunction sister chromatids.Therefore,SUMOylation plays an important role in regulating the chromosomal aneuploidy of oocytes;the exact mechanisms via which the SUMOylated substrates affect aneuploidy in oocytes remain unclear.This articles reviews the roles of SUMOylation in premature separation and non-isolated chromatid aneuploidy in oocyte from the effects of SUMOylationon Cohesin protein complex and microtubule dynamics.
2019, 41 (3): 425-429
YANG Kun,WANG Yan
Human optic nerve injury and its associated neurodegenerative diseases are often followed by permanent vision loss.Stem cell therapy has long been considered a promising mode to treat retinal degenerative diseases.Recent studies revealed that there are silent retinal stem cells in the eyes of mammals and even humans.These stem cells can be activated again under certain conditions and differentiate into retinal neurons to repair the damaged retina.Wnt signaling pathway plays a crucial role in conducting growth-stimulating signals and regulates cell proliferation,differentiation and apoptosis.This article review the regulatory effect of Wnt signaling pathway on stem cells-based retinal regeneration and the sources of retinal stem cells.
2019, 41 (3): 430-434
ZHANG Weiyu,WANG Huanrui,HU Hao,WANG Qi,ZHANG Xiaopeng,XU Kexin
Bladder cancer is a urological malignant tumor with high morbidity and mortality. Masses protruding into the bladder cavity is an important feature for clinical diagnosis of bladder cancer. However,patients with encrusted bladder cancer(EBC)do not present with masses protruding into the bladder cavity and thus this malignancy is often misdiagnosed. Four patients were admitted in Peking University People’s Hospital from July 2015 to February 2017. All of them were males aged 40 to 77 years(mean:58 years). Patients were mainly manifested as frequent urination,urgency,nocturia,and decreased bladder capacity,with or without difficulty of voiding.Although the bladder walls were markedly thickened,there was no obvious mass on imaging scans. Three patients received urodynamic test,which showed the maximum capacity of the bladder was 41 to 128 ml(mean:91 ml). One patient presented with gross hematuria,two patients presented with microscopic hematuria,and the remaining one patient had no hematuria. No mass was observed by cystoscopy. All of the patients were diagnosed with bladder cancer by repeated biopsy or intraoperative frozen section analysis.
2019, 41 (3): 435-442
ZHANG Xiang,WANG Yahong,CHEN Yuexin,LIU Bao,ZHENG Yuehong
Leiomyosarcoma(LMS)of the great saphenous vein(GSV)is a rare condition that is often misdiagnosed due to the lack of typical clinical manifestations.This article reported a GSV-LMS case diagnosed and treated in Peking Union Medical College Hospital.Meta-analysis of the current case and 41 cases derived from CNKI,WANFANG DATA,and MEDLINE database was also conducted,which revealed that the male to female ratio of GSV-LMS was 11∶10;the median age of disease onset was 59.5 years;the most commonly affected region was thigh.Due to lack of specific clinical features,42.9% of GSV-LMS patients were misdiagnosed at presentation.Radical resection is the most effective therapy,and the indications,effectiveness and protocols of adjuvant radiochemotherapy remain unclear.The 3-and 5-year overall survival rate was 86.1% and 77.5%,respectively.Recurrence and metastasis occurred in 31.0% of patients after surgery.