Volume 93  ·   Issue 26  ·  2013

To verify the application safety of medical anti-adhesion modified chitosan (Baifeimi) in cardiac surgery.

From August to December 2010,42 patients undergoing surgery for congenital heart disease,valvular heart disease or ischemic heart disease were selected and divided into testing (n=22) and control (n=20) groups.After complete intraoperative hemostasis, two sheets of anti-adhesion modified chitosan (Baifeimi) were placed on the surface of heart and vessels in the testing group and then chest was closed.And the control group underwent routine chest closing without an application of Baifeimi. The systemic and local reactions and drainage fluid were observed.The postoperative drainage fluid was subject to bacteria culture.Blood routines and laboratory tests at preoperation and Day 1 and Week 1 postoperation were performed to evaluate the changes of chemical, biological and immunological parameters.

There was no occurrence of systemic reaction, local inflammation or exudation.Wounds were healed at PhaseⅠ.The drainage fluid of pericardium and mediastina had no significant intergroup difference.Drainage was unobstructed in the testing group.A comparison of two groups revealed that the differences of aspartate aminotransferase ((24±17) vs (40±22) U/L), preoperative and postoperative immunoglobulin A ((1.9±0.7) vs (2.9±1.4) g/L, (2.3±0.9) vs (3.3±1.5) g/L) were statistically significant (all P<0.05).But the average values of both group stayed within a normal range without clinical significance while other indices had no significant difference.The bacteria cultures of all patients in the control group were negative.

Anti-adhesion modified chitosan is both convenient and safe for clinical application.The duration of cardiac surgery is not extended.No systemic or local adverse event is reported.There is no interference of hepatic, renal or immune functions.

To explore the effects of surgical operation on helper-inducer Tlymphocytes (Th1/Th2) in sino-nasal neoplasms.

From January 2004 to December 2011,80 patients with malignant tumor in nasal cavities or sinuses were enrolled as experimental group and another 80 subjects with deflection of nasal septum as control group.The phorbol-12-myristate-13-acetate (PMA) -stimulated peripheral blood mononuclear cells (PBMC) were obtained from both malignant tumor and normal control tissues.And flow cytometry was used to detect the expression percentages of interleukin-4 (IL-4) in Th2 cell and interferon-gamma (IFN-γ) in Th1 cell at pre and post-operation.

The preoperative expression percentage of CD3⁺CD8^-IL-4⁺ cell in malignant tumor patients was higher than that in controls (6.6%±1.7% vs 2.8%±1.7%,P<0.05) while the expression percentage of CD3⁺CD8^-IFN-γ⁺cell was lower (18.7%±5.7% vs 59.3%±1.5%,P<0.05).The preoperative expression percentage of CD3⁺CD8^-IL-4⁺cell was higher than that at postoperation (6.6%±1.7% vs 2.8%±1.5%, P<0.05).And the postoperative expression percentage of CD3⁺CD8^-IFN-γ⁺cell was higher than that at preoperation (54.0%±4.0% vs 18.7%±5.7%, P<0.05).

Surgery may restore the immune balance in patients with malignant tumors in nasal cavities or sinuses.

To explore the clinical features, diagnosis and surgical treatment of parathyroid neoplasms.

From January 2003 to December 2011, a total of 51 patients were recruited.Their clinical data, presentations, examinations and surgical approaches were analyzed retrospectively.

Among them, there were parathyroid adenoma (n=32), parathyroid cysts (n=18) and parathyroid carcinoma (n=1).The sensitivity and positive rate of neck ultrasonography and ⁹⁹Tc^m-methoxyisobutylisonitrile (MIBI) were 84.3% and 93.5%, 91.7% and 100.0% respectively.The high levels of serum calcium and parathyroid hormone (PTH) in 32 cases of parathyroid adenoma and 1 case of parathyroid carcinoma returned to normal after operation.The levels of serum calcium and PTH remained normal in 18 cases of parathyroid cysts.

The clinical manifestations of parathyroid adenoma were complex.The serum levels of calcium and PTH and neck ultrasonography are preferred screening tools for parathyroid neoplasms. ⁹⁹Tc^m-MIBI is suitable for tumor localization.Surgery is effective and safe for parathyroid neoplasm.Real time intraoperative monitoring of PTH is of great importance.

To summarize the clinical characteristics of adrenal cysts and compare the therapeutic results of two different laparoscopic surgical techniques.

Sixteen patients of adrenal cysts were summarized retrospectively from May 2005 to June 2012.Their clinical manifestations, pathological features, therapeutic effects and prognosis were analyzed.There were 7 males and 9 females aged 39.4 (25-68) years.Eight patients were symptomatic and the others were identified incidentally.They underwent laparoscopic surgery through retroperitoneal space, including adrenalectomy (n=11) and decortication (n=5).

All were confirmed as adrenal cysts by postoperative pathological examination.It accounted for around 7.5% of adrenal disease treated surgically at our department coetaneous.The diagnostic accuracy of computed tomography and magnetic resonance imaging was 11/16 and 3/3 respectively.The mean diameter of cyst was 5.3 (1-14) cm and no apparent endocrine abnormalities were found.The symptoms of 7/8 patients were relieved after a mean 48 months follow-up.No recurrence was found in this cohort.The average operative duration and estimated volume of blood loss were significantly less in laparoscopic decortication group ((48±10) min, (16±11) ml) than laparoscopic adrenalectomy group ((74±21) min, (34±30) ml).

Laparoscopic surgery is an effective procedure for the treatment of adrenal cysts.And retroperitoneal laparoscopic decortication may be preferred treatment option for large benign adrenal cysts.

To explore the diagnosis and treatment of tuberous sclerosis complex complicated with renal angiomyolipoma.

The clinical data of 22 patients with tuberous sclerosis complex complicated with renal angiomyolipoma were analyzed retrospectively.

There were 12 males and 10 females with a mean age of 23 (1-46) years.All of them had bilateral multiple renal angiomyolipomas.The mean tumor size was 8.5 (0.7-18.0) cm in diameter.The presence or absence of clinical symptoms showed a significant correlation with tumor size.Eight patients with angiomyolipoma under 4 cm in diameter were continuously monitored at an outpatient clinic.There were 8 patients with lesions of 4-10 cm.Five of them underwent nephron-sparing surgeries and another 3 monitored at an outpatient clinic.There were 6 patients with tumor over 10 cm.Three of them underwent transcatheter arterial embolization and one case took rapamycin after embolization.One patient with concurrent renal cell carcinoma underwent partial nephrectomy.Chronic renal failure occurred in one case dying of pulmonary lymphangiomyomatosis with serious hemoptysis.During a mean follow-up of 25 months, neither severe renal hemorrhage nor symptomatic aggravation was found.In the case of rapamycin, there was 10% reduction in the size of angiomyolipoma.

Most cases of tuberous sclerosis complex are complicated with bilateral multiple renal angiomyolipoma.The small lesions under 4 cm in diameter may be monitored at an outpatient clinic.For those larger (>4 cm) or symptomatic ones, medication,embolization or surgery is necessary.

To explore the effects of allitridi capsules on endothelial function and clinical prognosis after percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients with diabetes mellitus (DM).

A total of 120 CAD patients with DM undergoing PCI were randomly assigned to receive conventional (control,n=60) and additional allitridi treatment (120 mg/day,n=60) for 3 months.Serum nitric oxide (NO) and intercellular adhesion molecule 1 (ICAM-1) levels were determined by enzyme-linked immunosorbent assay (ELISA) immediately and at 3 months post-PCI.Endothelial function was assessed by endothelium dependent flow-mediated dilation (FMD).Duration of follow-up was 1 year after PCI.

The clinical characteristics, serum NO and ICAM-1 levels and FMD at baseline were not different between two groups.At Month 3 post-PCI, serum NO level was markedly higher ((147±32) vs (112±24) μmol/L, P=0.009) and serum ICAM-1 level was significantly lower ((182±21) vs (232±29) μmol/L, P=0.021) in the allitridi group than in the control group.Furthermore, treatment of allitridi resulted in a significant improvement of FMD (8.2%±2.4% vs 6.4%±2.3%, P=0.013).At Year 1 post-PCI, the incidence of major adverse cardiovascular event (MACE) was lower in the allitridi group than that in the control group (10.5% vs 17.2%,P=0.022).

Allitridi capsules significantly improve the clinical prognosis after PCI in CAD patients with DM.Its mechanism may lies in improved endothelial function and vascular inflammatory state.

To evaluate the relationship between cardiovascular risk factors and cognitive function in a healthy population.

A community-based cross-sectional study was conducted in Shenyang.The Framingham gender-specific risk equation was employed to evaluate the cardiovascular risk factors, calculate Framingham risk score and estimate the risk of 10-year coronary heart disease (CHD).A total of 505 study subjects were divided into 3 groups according to 10-year CHD risk: low risk (<10%), moderate risk (10%-20%) and high risk groups (>20%).They were also divided into 5 groups according to age; ≤44 year old; 45-54 year old; 55-64 year old; 65-74 year old and ≥75 years old.Clock drawing test and mini-mental state examination (MMSE) were used to evaluate the cognitive function and compare it among different risk groups.And correlation coefficients between Framingham risk score and cognitive function were calculated.

Framingham risk score,clock drawing test sore and MMSE score in the low risk group was (2.6±0.8), (4±1) and (27±3).In comparison to low risk group, Framingham risk score increased significantly (P<0.01), MMSE score (25±4) decreased significantly (P<0.01) in moderate risk group, Framingham risk score (9.7±1.0) increased significantly (P<0.05) and clock drawing test scores (3±1) and MMSE scores (23±4) decreased significantly (P<0.05) in high risk group; in comparison to moderate risk group, clock drawing test and MMSE scores decreased significantly (P<0.05) in high risk group.There was a significantly inverse correlation between Framingham risk score and cognitive function.And the Pearson correlation coefficients were -0.196 (clock drawing test,P<0.01) and -0.333 (MMSE, P<0.01).

An inverse correlation exists between cardiovascular risk factors and cognitive function in healthy population.With more risk factors and greater severity, Framingham risk score increases while cognitive function decreases.

To explore the etiologic characteristics of adult patients with communityacquired pneumonia (CAP) in Beijing.

A multicenter cohort of 510 adult CAP patients were enrolled from Beijing during the period of November 2010 to May 2012.Multiplex polymerase chain reaction (PCR), real-time fluorescence quantitative PCR and legionella urinary antigen were used to detect common respiratory viruses, Mycoplasma pneumoniae and legionella respectively.Bacteria were detected by sputum culture, blood culture and Streptococcus pneumoniae urinary antigen.Statistical analyses were performed for the etiologic characteristics and seasonal distribution of detected pathogens.

Pathogens were detected in 240/500 (47.1%) study patients.The mixed infection of different pathogens was present in 42 cases (8.2%), viruses in 164 (32.2%), Mycoplasma pneumoniae in 91 (17.8%), bacteria in 26 (5.1%) and Legionella in 3 (0.6%).Among 164 patients infected with viruses,194 viral strains were detected.Influenza virus represented the greatest proportion with 105 (54.1%) in viral infections.Between November 2010 to October 2011, Influenza A infections increased gradually in November 2010, peaked in February 2011 and declined by March 2011 in China. Mycoplasma pneumoniae was predominant in winter and spring.

There is a high detection rate of virus and Mycoplasma pneumoniae in adult CAP patients in Beijing.And more consideration should be given to influenza virus and Mycoplasma pneumoniae infections in winter and early spring.

To evaluate the diagnostic value of cerebral spinal fluid (CSF) measurement of hypocretin-1 (hcrt-1) in Chinese patients with narcolepsy.

A total of 139 narcoleptic patients, including 111 narcolepsy with typical cataplexy (NC) and 28 narcolepsy without cataplexy (NWC), were diagnosed at the sleep centre of Peking University People′s Hospital from April 2003 to March 2012.And 64 non-narcoleptic controls were recruited.CSF hcrt-1 levels were measured in all subjects.Receiver operating characteristic curve (ROC) was applied to determine the cutoff value of hcrt-1 for Chinese narcolepstic patients.The diagnostic utility of hcrt-1≤110.0 ng/L and hcrt-1≤30% of mean normal level defined by International Classification of Sleep Disorders-Ⅱand the new Chinese cutoff value were evaluated respectively.

The level of hcrt-1 in narcolepsy patients was significantly lower than that of normal controls and the NC group was even lower than NWC group (20 (13, 36) vs 319 (244, 379) and 36 (15, 114) ng/L)(all P<0.01).Using the international criteria of CSF hcrt-1≤110.0 ng/L or a level of 1/3 of mean normal control values, a specificity of 100% and sensitivity of 90.6% were generated.ROC curve indicated that CSF hcrt-1 level of 138.0 ng/L was the best cutoff value for the diagnosis of narcolepsy in Chinese narcoleptic patients.There were a specificity of 100%, a sensitivity of 92.8% and the area under the ROC curve of 0.98.

CSF hcrt-1 measurement with high specificity and sensitivity is a useful diagnostic tool for Chinese narcoleptics.And the level of 138.0 ng/L may be the optimal cutoff for the diagnosis of narcolepsy in this group of patients.

To explore the occurrence of complex sleep apnea syndrome in patients with obstructive sleep apnea during continuous positive airway pressure titration and evaluate their polysomnographic characteristics.

A total of 420 patients with obstructive sleep apnea were recruited to undergo an overnight continuous positive airway pressure titration at the Sleep Medicine Center, West China Hospital from January 2010 to December 2012.Their polysomnographic records of respiratory events, oxygen desaturation events and sleep stages were retrospectively reviewed.

The incidence of complex sleep apnea syndrome was 7.9% (33/420) and central apnea index (9.0±5.1)/h.No significant differences existed in age, gender, body mass index and titration pressure of continuous positive airway pressure between two groups.Compared with those with non-complex sleep apnea, complex sleep apnea patients had significant increases in apnea/hypopnea index (12.8/h vs 3.6/h, P<0.05) and oxygen desaturation index (10.3/h vs 3.8/h, P<0.05) which mainly happened in non-rapid eye movement stage.They also showed decreases in total sleep time ((365±96) vs (402±77) min), rapid eye movement stage (16%±8% vs 20%±10%), increases in non-rapid eye movement stage 1 (24%±17% vs 15%±13%), wakefulness after sleep onset ((108±93) vs (79±61) min) and brief arousal index ((28±15) vs (20±12)/h).And the differences were statistically significant (all P<0.05).

Complex sleep apnea syndrome is common among Chinese patients with obstructive sleep apnea.Compared with those with non-complex sleep apnea, complex sleep apnea patients have reduced sleep time and worse sleep quality during continuous positive airway pressure therapy.

To elucidate the mechanism of Hedgehog pathway in the metastasis of gastric cancer and examine particularly the effect on epithelial-mesenchymal transition (EMT).

Using pharmacological and siRNA knockdown approach, the Hedgehog pathway was inhibited.The cellular morphology, protein level, invasion and metastatic abilities were measured by microscope, Western blot, Transwell invasion assay and Transwell migration assay.

Under the inhibition of Hedgehog pathway, the invasive and migration abilities of gastric cancer decreased.The transforming growth factor (TGF) -βcould induce spindle-like-shaped morphological changes with a down-regulation of epithelial characteristic (decreased E-cadherin protein level) and an up-regulation of mesenchymal characteristics (increased Vimentim protein level).There were concurrent increases of invasive and migration potentials by 3 and 4 folds respectively.However, under the continuous stimulation of TGF-β, the inhibition of Hedgehog pathway could reverse the EMT changes, lower the expression of vimentim and reduce the invasion and metastatic abilities by 3 and 2 folds respectively.

The inhibition of Hedgehog pathway can decrease the TGF-β-inducing EMT.It suggests that Hedgehog pathway may play a critical role in the metastasis of gastric cancer.

To explore the effects of statin on pro-inflammatory macrophage phenotype in a murine M1 macrophage model.

Macrophages isolated from murine bone barrow were stimulated with interferon-gamma (IFN-γ) and lipopolysaccharide (LPS) to establish a M1 macrophage model.And 1.0,2.5,5.0μmol/L of simvastatin were added to M1 macrophages for a 9-hour culture.Cell surface markers CD16/23 and CD206 were detected by fluorescence activated cell sorter (FACS) and interleukin-10 (IL-10) and IL-12 by ELISA.

The CD16/32 expression was 86.39%±2.24% and IL-12 secretion (1562±217) pg/ml in IFN-γand LPS-stimulated macrophages.After a 9-hour incubation with 1.0, 2.5, 5.0μmol/L simvastatin, the CD206 expression levels were 68.10%±2.48%, 75.28%±1.66%, 86.32%±2.19% and the secretion of IL-10 (500±5), (675±28) and (916±15) pg/ml respectively.By analysis of variance and q test of mean, the difference was statistically significant (all P<0.01) between the groups of M1 model (9.67%±5.48%, (298±11) pg/ml).And the phenotypic features were similar to those of the groups of M2 model.

Simvastatin may inhibit inflammation by enhancing the switching of M1 macrophage to M2 macrophage phenotype.

To evaluate the feasibility, safety and short-term outcomes of total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction.

From July 2012 to February 2013, 21 patients underwent total laparoscopic surgery with transanal natural orifice specimen extraction.There were 12 males and 9 females with a median age of 53 (48-77) years.Rectal cancer (n=11) and sigmoid cancer (n=10) were diagnosed.The clinical data such as bowel function recovery time, number of lymph nodes harvested and an incidence of anastomotic leakage was collected and retrospectively analyzed to assess the value of this technique.

Operation was successfully accomplished without conversion into open surgery or conversional laparoscopic-assisted surgery.The median operative duration was 105 (80-165) min, the median volume of blood loss 50 (20-300) ml, the median number of lymph nodes harvested 16 (8-29) and the time of first bowl movement was 48 (24-72) h.The postoperative hospitalization stay was 9 (6-12) d.There were abdominal hemorrhage (n=1) and anastomotic leakage (n=1).

Total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction appears to be feasible, and oncologically acceptable for selected patients.

To evaluate a rapid matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) assay in detecting carbapenemase-producing Enterobacteriaceae.

Thirty-four carbapenemase-producing Enterobacteriaceae and 50 carbapenem susceptible Enterobacteriaceae clinical isolates were tested.After a 2-hour incubation of bacteria with meropenem, the mixtures were centrifuged and the supernatants analyzed by MALDI-TOF MS.

All spectra of carbapenem susceptible Enterobacteriaceae showed peaks of m/z 384, 406, 428 while those of carbapenemase-producing Enterobacteriaceae m/z 358, 380,402, 424, 446,468.And the assay of MALDI-TOF MS was highly consistent with sequencing (P=1.000).

MALDI-TOF MS can detect carbapenemase-producing Enterobacteriaceae rapidly and accurately.