Volume 92  ·   Issue 42  ·  2012

Constipation is a common and frequently occurring disease. According to the statistics of different regions in China, the prevalence rate of constipation is 3% ~17% [1], and it is as high as 23% among the elderly [2]. Although constipation does not directly endanger life, the symptoms of abdominal pain, abdominal distension, anal and rectal drop and various general discomfort caused by it seriously reduce the quality of life of patients and interfere with their normal working mood [3]. Doctors are often confused because they cannot completely cure constipation. Facing the expectation from patients and the pressure of repeated treatment, how should doctors adjust their thinking and improve the treatment effect? Now, several questions worth considering in the treatment of constipation are put forward to discuss with readers.

Objective To evaluate the effects of different doses of lactulose on preventing oral morphine-induced constipation.Methods From January 2011 to May 2012,a total of 112 patients received oral lactulose solution to prevent morphine-induced constipation at our hospital and their clinical data were retrospectively analyzed.The doses of morphine were adjusted according to the pain scores and lactulose was taken simultaneously.There were 52 males and 60 females.They were randomized into Group 30 ml/d (n =40),Group 60 ml/d (n =43) and Group 90 ml/d (n =29).The incidences of constipation and adverse reactions were obtained at 1 week after the start of medicine.The measurement data were analyzed with analysis of variance.And the enumeration data were analyzed with x2,Kruskal-Wallis and Mann-Whitney U tests.Results The incidence of constipation was 67.5％ (27/40) in Group 30 ml/d,46.5％ (20/43) in Group 60 ml/d,and 37.9％ (11/29)in Group 90 ml/d.And there were statistical differences(P =0.036).The incidence of constipation in Group 30 ml was significantly higher than Group 90 ml/d(P =0.015).No statistical difference existed in the incidence of constipation between Groups 30 ml/d and 60 ml/d (P =0.054) or Groups 60 ml/d and 90 ml/d (P =0.471).The incidence of vomiting was 34.5％ (10/29) in Group 90 ml/d and it was significantly higher than 10.0％ (4/40) in Group 30 ml/d (P =0.013) and 9.3％ (4/43) in Group 60 ml/d (P =0.009).No statistical difference existed in the incidence of vomiting between Groups 30 ml/d and 60 ml/d (P =0.915).The incidence of diarrhea was 17.2％ (5/29) in Group 90 ml/d and it was significantly higher than 0 (0/40) in Group 30 ml/d (P =0.007).No statistical difference existed in the incidence of diarrhea between Groups 30 ml/d and 60 ml/d (4.7％ (2/43),P =0.170) or Groups 60 ml/d and 90 ml/d (P =0.072).Conclusion The correct dosage of lactulose for the prevention of oral morphine-induced constipation is 60 ml/d.

Objective To analyze the clinical features,risk factors and drug uses of senior hospitalized patients with chronic constipation.Methods A total of 162 hospitalized patients aged 85 years and over at our hospital during the period of January-March 2012 conducted a questionnaire survey.There were 137 males and 25 females.And 112 cases of chronic constipation were diagnosed in accordance with the Rome Ⅲ criteria.The survey included general condition,risk factors of constipation,spectrum of symptoms,associated symptoms,previous medication and medication for constipation after admission.The results were statistically analyzed by Logistic regression.Results Their average age was (90 ± 4) years old.And the total prevalence of chronic constipation was 69.1％ (112/162).Logistic regression analysis showed that less activity (OR =10.873) and diet (OR =4.752) were the important risk factors.Defecation effort was the most common symptom (n =85,75.9％).A total of 88 cases (78.6％) took lactulose alone or lactulose plus other laxatives.The reasons of using lactulose were as follows:dietary restrictions (n =31,35.2％),aspiration prevention (n =21,23.9％) and poor efficacy of other laxatives (n =36,40.9％).Conclusions Prevalence of constipation is high among senior hospitalized patients.Less activity and diet are the main risk factors.And lactulose should be a first-line therapy.

Objective To explore the therapeutic efficacy and safety of lactulose plus live binary Bacillus subtilis in elders with functional constipation.Methods A total of 97 elder outpatients or inpatients with functional constipation at our department from September 2011 to April 2012 were divided into 3 groups:lactulose treatment (n =32),live binary Bacillus subtilis treatment (n =31) and combined treatment (n =34).Among them,there were 57 males and 40 females with an average age of (74 ± 6) years old.The course of treatment was 4 weeks in all groups.Then we observed the effective time,therapeutic efficacy,adverse reaction and change of life quality.Results (1) There were 62.5％ (20/32) effective patients in the lactulose treatment group,41.9％ (13/31) in live binary Bacillus subtilis treatment group and 82.4％(28/34) in combined treatment group during 48 hours.Combined treatment group was significantly higher than lactulose treatment group (P ＜ 0.05) and live binary Bacillus subtilis treatment group (P ＜ 0.01).And lactulose treatment group was higher than live binary Bacillus subtilis treatment group (P ＜ 0.05).(2)After 4 weeks,the total effective rates were 68.7％ (22/32),41.9％ (13/31) and 94.2％ (32/34)respectively.Combined treatment group was significantly higher than lactulose treatment group (P ＜ 0.05)and live binary Bacillus subtilis treatment group (P ＜ 0.01).Meanwhile,lactulose treatment group was superior to live binary Bacillus subtilis treatment group (P ＜ 0.05).(3) After 4 weeks,there was no statistic difference in total adverse reaction rates among 3 groups (P ＞0.05).(4) The life quality score of combined treatment group was significantly higher than lactulose treatment group (P ＜ 0.05) and live binary Bacillus subtilis treatment group (P ＜ 0.01) and lactulose treatment group was higher than live binary Bacillus subtilis treatment group (P ＜ 0.05) after a 4-week treatment.Conclusions The combined regimen of lactulose and live binary Bacillus subtilis is more effective than lactulose or live binary Bacillus subtilis alone.Besides,there is no significant increase in adverse reactions.Thus the combined regimen of lactulose and live binary Bacillus subtilis is an effective and safe therapeutic method for elders with functional constipation.

Objective To explore the efficacies of live combined Bacillus Subtilis (B.Subtilis) and Enterococcus Faecium (E.Faecium) Capsules plus lactulose in the treatment of functional constipation.Methods A total of 216 patients fulfilling the diagnostic criteria of functional constipation (slow transit pattern) were randomly enrolled from 9 participating hospitals and allocated into treatment group and control group.The patients of treatment group received lactulose plus live combined B.Subtilis and E.Faecium Capsules for 14 days and only took the latter during the following 14 days.The patients of control group received lactulose plus placebo for 2 weeks and then only took placebo continually for the following 2 weeks.Results A total of 216 patients were analyzed (treatment group n =104,control group n =112).The effective rates of 7-day treatment were 88.46％ (n =92) and 84.82％ (n =95) for treatment and control groups respectively.And those of 28-day treatment were 87.50％ (n =91) and 81.25％ (n =91)respectively.And the inter-group differences were not statistically significant (all P ＞ 0.05).Fecal form,frequency,difficulty,urgency,distension,abdominal pain and expelling rates of barium enema were not statistically significant (all P ＞ 0.05).Comparing the effective rates of 28-day with that of 14-day,differences were not statistically significant in A group (S =0.5,P =0.4795),but in B group the effective rates of 28-day were lower than that of 14-day statistically (S =11,P =0.0009).Conclusion The regiment of live combined B.Subtilis and E.Faecium Capsules plus lactulose offers better efficacies in the treatment of functional constipation.

Objective To explore the chemotherapeutic efficacies and prognostic factors of metastatic triple-negative breast cancer.Methods The clinicopathologic data of 151 patients with metastatic triple-negative breast cancer were collected from September 1994 to November 2011 and their clinicopathologic characteristics,recurrence and survival were analyzed.Results Platinum plus taxol or vinorelbine was significantly higher than others for these patients (42.1％ vs 23.1％,P =0.022).The median overall survivals of those on first-line chemotherapy with partial remission,stable disease and progressive disease were 29.6,24.7 and 13.1 months respectively.The differences were statistically significant (P =0.045).Two or three-line chemotherapy showed no obvious statistical relationship with total overall survival.Simple factor analysis showed that the number of metastasis,visceral metastases and the efficacies of first-line chemotherapy were correlated with overall survival (all P ＜ 0.05).Multivariate Cox regression showed that disease-free survival and the efficacies of first-line chemotherapy were the independent prognostic factors of metastatic triple-negative breast cancer.Conclusion The combined chemotherapy of platinum may achieve better efficacies in the treatment of metastatic triple-negative breast cancer.And the efficacies of first-line chemotherapy are closely correlated with survival.

Objective To evaluate the safety and efficacy of sorafenib plus cisplatin in the treatment of metastatic renal cell carcinoma (mRCC) with pleural effusion.Methods A total of 30 patients with mRCC (clear cell carcinoma) with pleural effusion from April 2009 to January 2011 were recruited.All received sorafenib 400 mg twice daily.And 11 patients in chemotherapy group received sorafenib plus local chemotherapeutic perfusion of cisplatin 40 mg weekly for 2 weeks while another 19 patients in control group received sorafenib alone.Results The response rate of pleural effusion was 10/11 for chemotherapy group versus 3/19 for control group (x2 =13.097,P ＜ 0.01).Followed up to April 30th,2011,5 of 11 patients in chemotherapy group and 10 of 19 patients in control group died.Among those on sorafenib,the median overall survival time was 22 months(95％ CI:2.12-41.88)for local chemotherapy versus 9 months(95％ CI:8.20-9.80) without local therapy(P =0.04).The most common events in local chemotherapy group were Ⅰ-Ⅱ thoracic pain,nausea and vomiting.And the incidence rates were 8/11 and 9/11 versus 4/19 and 3/19 respectively (P ＜ 0.01).The main laboratory abnormalities were similar in two groups.Conclusion The regimen of sorafenib plus pleural cavity perfusion of cisplatin is both effective and safe in the treatment of mRCC with pleural effusion.It may control local symptoms and achieve a better overall survival.

Objective To explore the clinical features,pathomorphology,immunohistochemical characteristics and prognosis of Langerhans cell histiocytosis (LCH) in adults.Methods Twenty-three cases of adult LCH were retrieved from Ningbo Diagnostic Pathology Center during the period from January 2005 to December 2011.And their clinical presentation,pathomorphology and immunohistochemical characteristics were analyzed.Results The mean age of patients was 37.2 years (range:20-58).The male-to-female ratio was 1.6∶ 1.Of 23 LCH patients,26 lesions were found including 14 bone tissue lesions (53.8％),followed by 4 lymph node lesions and 4 skin lesions (both 15.4％),as well as 1 soft tissue,liver,parotid and buccal lesion respectively (all 3.8％).Clinically,unisystem and unifocal disease was predominant (19 cases,82.6％),followed by unisystem and multifocal disease (1 case,4.3％),multisystem disease (3 cases,13.0％).Histologically,all cases of LCH revealed diffused distribution of Langerhans cells,accompanied by a variable number of eosinophils,lymphocytes,neutrophils and multinucleated giant cells.Immunohistochemically,the expression of CD1a,Langerin,S-100 protein and CD68 was 100％ (23/23),100％ (20/20),95.6％ (22/23) and 90.5％ (19/21) respectively.All lesions were treated by surgical therapy.Sixteen patients were available for follow-up examination and 14 patients survived.The 3 and 5-year cumulative survival rates were 92.9％ and 79.6％respectively.Conclusions LCH of adults occurs predominantly in bone and presents mainly as unisystem or unifocal defects.Surgical excision is generally effective and the prognosis is fair.

Objective To evaluate the efficacy and safety of brachytherapy plus operation for salivary gland malignant tumors.Methods From June 2006 to June 2011,a total of 105 patients with salivary gland malignant tumors undergone brachytherapy by implantation of iodine 125 seeds.The effectiveness was evaluated by periodical radiological film and computed tomography.The complications were analyzed.Results Among them,92 patients were observed for 12-60 months.The rates of clinical response rate (CRPR) and no change (NC) were 91.3％(84/92) and 8.7％ (8/92) respectlvely of the patients.Pain,mucosa ulcer,skin darkness and radiation osteomyelitis were common complications.Conclusion The combined regimen of operation and brachytherapy of iodine 125 seed implantation for salivary gland malignant tumors is quite effective and convenient.And it has fewer complications.

Objective To explore the clinical features of IgG4-related systemic diseases (IgG4-RSD)Methods A total of 8 inpatients with IgG4-RSD diagnosed at our hospital during August 2010 to December 2011 were recruited.We analyzed the clinical data,laboratory profiles,radiological and pathologic features and prognostic factors of these patients with IgG4-RSD.Results There were 5 males and 3 females with a mean onset age of 52.5 years.IgG4-related diseases were described in multiple organ systems:pancreas (n =5),biliary tree (n =3),kidneys (n =6),lungs (n =3),aorta and periaortic tissue,retroperitoneum (n =5) and lymph nodes (n =6).Hyperglobulinemia,elevated serum levels of IgG and IgG4,anemia(n =6),renal dysfunctions(n =5) and obstructive jaundice (n =2) were common laboratory findings.Lymphoplasmacytic infiltration and fibrosis were common pathologic findings.A diffuse infiltration of plasma cells with over 30 IgG4-positive cells per high-power field provided compelling evidences of IgG4-related disease.Patients with IgG4-RSD responded well to glucocorticoids.Conclusion With heterogeneous clinical characteristics,IgG4-RSD is found in various organ systems.The prominent histopathologic features of IgG4-RSD include a diffuse infiltration of plasma cells with over 30 IgG4-positive cells per high-power field.And the therapy of glucocorticoids is efficacious.

Objective To estimate the efficacies of different first-line treatments for advanced stage kidney cancer.Methods For this observation controlled trial,a total of 82 cases with advanced stage kidney cancer from 2006 to 2011 were recruited.They were divided into 3 groups and accepted gemcitabine plus interleukin-2 (IL-2) (Group A),oxaliplatin plus capecitabine (Group B) or sorafenib alone (Group C).Results Among them,76 patients had complete data.The overall response rates of A-C groups were 39.3％ (11/28),37.0％ (10/27) and 38.1％ (8/21) respectively.And there was no significant difference (x2 =0.029,P =0.986).And their progression-free survival (PFS) rates were 9.1 (95％ CI:7.9-10.3),7.5 (95 ％ CI:5.5-9.5) and 10.9 (95 ％ CI:10.5-11.3) months respectively.And there were significant differences (P =0.013).Average daily treatment costs were 490,498 and 501 Chinese yuan respectively.And there was no significant difference (P =1.240).Because of toxicity,2 and 3 cases withdrew in Groups A and B respectively.Conclusion Gemcitabine plus IL-2 and oxaliplatin plus capecitabine have similar early efficacies and tolerance profiles for the patients who can not accept sorafenib as first-line treatment.

Objective To explore the application of thulium laser (2 μm laser) in managing bladder cuff in nephroureterectomy for upper urinary tract urothelium carcinoma (UUT-UC).Methods The medical records of 56 patients undergoing nephroureterectomy at our hospital were reviewed retrospectively.The operative indicators,oncologic outcomes and clinicopathologic data were compared among the groups of open surgery (Group A),electric coagulation (Group B) and thulium laser technique (Group C).Furthermore a model of burst pressure measurement was built to measure the different burst pressures of sealing distal ureter.Results The follow-up results:when the indicators of operative duration,intraoperative blood loss volume,removal time of drainage tube,removal time of catheter and hospital stays were compared among three groups,Group A had no statistical differences with Group B/C in terms of removal time of drainage tube and removal time of catheter.But significant statistical differences existed in terms of operative duration,intraoperative blood loss volume and hospital stays ((232 ± 52)vs (148 ± 47)and (130±49) min,(358±81) vs (136±74) and (145±70) ml,(13 ±3) vs (11 ±4) and (10±3)d,all P ＜ 0.05).No statistical differences existed between Groups B and C in terms of all the above indicators.Burst pressure measurement results:no statistical differences existed between Group C and B ((116±21) vs (139 ±32) cm H2O,P＞0.05).Conclusions For the surgical treatment of UUT-UC,thulium laser technique has no difference in operation indicators and oncologic outcomes compared to open surgery.Besides,it has the advantages of improved spatial beam quality and more precise tissue incision.

Objective To explore the effects of glucagon-like peptide 1 (GLP-1 (9-36)) on endothelial nitric oxide synthase (eNOS) in human umbilical vein endothelial cells (HUVEC).Methods HUVEC cultured under the conditions of normal glucose (5.5 mmol/L) or high glucose (16.8 mmol/L)were incubated with 5-5000 pmol/L GLP-1 (9-36).NO production was assayed by the nitrate reductase method.The eNOS activities were detected by NOS assay kit,p-eNOS (ser-1177) level and total eNOS protein level by Western blot and eNOS mRNA level by real-time reverse transcription-polymerase chain reaction (RT-PCR).Results Under normal glucose condition,NO productions from HUVEC of 50-5000 pmol/L GLP-1 (9-36) groups were significantly higher than the control ((41.6 ± 8.1) μmol/L vs (22.2± 2.6)μmol/L,P ＜0.05).So were eNOS activities in cells (1.76± 0.12 vs 1.00 ± 0.00,P ＜0.05).Compared with the control group,the levels of eNOS phosphorylation at ser-1177,mRNA and total protein were significantly elevated in the 5000 pmol/L GLP-1 (9-36) group.Under high glucose condition,GLP-1(9-36) retained all the above effects.Conclusion GLP-1 (9-36) can increase NO release,eNOS activity and expression in HUVEC.This may be one of the underlying mechanisms for the protective effects of GLP-1 (9-36) on cardiovascular system.

Objective To observe the effects of lysyl oxidase (LOX) down-regulation on invasion,migration and epithelial-mesenchymal transition phenotype molecule E-cadherin protein expression,induced by hypoxia in lung cancer NCI-H460 cells.Methods Small interfering RNA against human LOX gene (LOX siRNA) was used to transfect lung cancer cells under normoxia (19％ O2).After a 24 h incubation,the cells were plated for 24 h in hypoxic incubator (0.5％ O2).Real-time polymerase chain reaction (PCR)was performed to detect the LOX mRNA expression.The protein levels of LOX and E-cadherin were determined by Western blot.And invasion and migration capacities were detected by transwell chamber.Results Compared with NCI-H460 cells under normoxia (set to 1),hypoxia increased to the levels of LOX mRNA and protein expression up to 26.04 ± 1.78 and 5.57 ± 1.27 respectively (both P ＜0.05).Compared with control siRNA group (set to 1),LOX mRNA and protein expression after LOX siRNA transfection were 0.24 ± 0.03 and 0.29 ± 0.03 respectively,cellular invasive and migratory capacities were 0.57 ±0.03 and 0.49 ±0.02 respectively,the protein expression of E-cadherin was 2.17 ±0.21 (all P ＜ 0.05).Conclusion LOX down-regulation reduces invasion and migration potentials of hypoxic human lung cancer cell and potentiates the protein expression of E-cadherin.

The patient was a 45-year-old male who was admitted to the hospital on August 25, 2011 due to "fever accompanied by cough and expectoration for 1 month". On July 16, 2011, the patient was smashed and injured on his right toe, with a small amount of local bleeding. He was disinfected with liquor by himself, and the local scab healed 3 days later. In late July, he developed fever, with the highest temperature of 41.0℃, accompanied by cough and yellow phlegm, without hemoptysis, chest pain and dyspnea, and self-administered "cold medicine" was ineffective.

The main component of androgen is testosterone. Physiological level of androgen not only plays a key role in male sex differentiation, development and maturation, the maintenance of normal male physiological function, spermatogenesis and maturation, but also affects the development of bone and muscle, the production of red blood cells, the sensory and cognitive function of the brain, etc. Low testosterone level is very common in clinic. Due to the different sensitivity and action points of target organs, male characteristics and physiological functions can be attenuated to varying degrees, including male erectile dysfunction (ED), delayed hypogonadism (LOH), delayed puberty, male infertility, etc. Testosterone supplementation therapy (TST) can not only promote spermatogenesis and maturation, but also produce many benefits for male hypogonadism patients.

Oxidative stress refers to a state in which the generation of total reactive oxygen radicals in the body exceeds the defense ability of antioxidant system, which is one of the main causes of multiple organ dysfunction or even failure in patients with severe burn. In recent years, some new hot spots have emerged in the research on antioxidation after burn. The damage mechanism of oxidative stress after burn and the main antioxidant measures at present are summarized as follows.

Glucagon-like peptide 1 (GLP-1), as a new direction in the development of drugs for the treatment of type 2 diabetes mellitus, has become a hotspot in the field of diabetes mellitus in recent years. It not only has a significant effect of reducing blood sugar, but also can improve the damage of pancreatic islet cells, reduce body weight and reduce the incidence of hypoglycemia in diabetic patients [1]. With the deepening of research on GLP-1, the research on GLP-1 receptor and its signaling mechanism has gradually deepened. GLP-1 receptor is one of the effective targets for the treatment of type 2 diabetes mellitus, and it also provides a good basis for further research and development of GLP-1 receptor agonist drugs [2].

Epidemiological observational research refers to a kind of research that uses observational method to objectively record the present situation and related characteristics of certain phenomena, so as to evaluate the impact of potential harmful exposure on individual health or public health, describe the present situation of diseases or treatment patterns, analyze rare or long-term adverse reactions of certain treatments, and determine the causal factors of diseases [1]. Accurate and detailed reporting of the design, methods, implementation and results of observational research is of great significance for editors, reviewers and readers to evaluate the academic level and application value of papers fairly and objectively, and for the promotion and reuse of authors' scientific research achievements.