Volume 93  ·   Issue 30  ·  2013

To evaluate the impact between home versus hospital enteral nutrition in patients with intestinal fistula.

A clinical trial containing 82 patients of intestinal fistula with enteralxx nutrition was conducted.All cases were divided into 3 groups: home enteral nutrition (n=42), hospital enteral nutrition (n=40）and normal control for assessment of quality of life (n=40).The incidence of complications, hospitalization duration, days of enteral nutrition and medical costs were compared between two enteral nutrition ways.Quality of life was assessed with SF-36 questionnaire at the same time.

Compared with the hospital enteral nutrition group, the home enteral nutrition group had a shorter hospital stay.The costs of treatment showed a signiflcant decrease and the quality of life significantly improved.No significant difference existed between two types in the length of enteral nutrition and the incidence of complications.

Home enteral nutrition is safe, rational and effective for patients with intestinal fistula.

To explore the relationship between the changes of estrogen, folliclestimulating hormone (FSH) and luteinizing hormone (LH) levels and bone mineral density (BMD) decreasing rate (BDR) at different skeletal regions and examine the effects of hormones levels on BDR.

An age cross-sectional study was conducted in 694 healthy adult women excluded from diseases and drugs affecting bone metabolism.Their age range was 20-80 years.The serum concentrations of FSH, LH and estradiol (E₂) were measured with radioimmunoassay.And BDR was measured with a DXA fanbeam bone densitometer at various skeletal regions including lumbar spine, left hip and left forearm.

The serum levels of FSH (r=-0.597 to -0.479, all P<0.01) and LH r=-0.452 to -0.283, all P<0.01) were significantly negatively correlated with BDR at various skeletal regions.Meanwhile, the serum level of E₂ only had slightly positive correlation with hip and distal forearm (r=0.077 to 0.122, all P<0.05).After adjusting age and body mass index (BMI), serum FSH still had markedly negative correlation with BDR at various skeletal regions.However, the correlation coefficients became weak.Multiple line regression stepwise analysis revealed that serum FSH was a negative determinant factor of BDR at various skeletal regions:20%-32% changes in BDR of various skeletal regions were determined by FSH, while LH only produced very small negative effects (0.6%-0.8%) on BDR of lumbar spine.Serum E₂ seemed to be a positive determinant factor of skeletal regions and 2.5%-5.4% changes in BDR were determined by E₂. The effects of serum FSH on BDR were approximately 3.8-12.8 folds than those of serum E₂.

BDR is correlated with increased FSH in women.The most critical factor for aging-related BDR is FSH in women while a decreased level of estrogen may be secondary.

To evaluate the relationship between high sensitivity C-reactive protein (hs-CRP) level and the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) in non-obese patients.

A total of 65 patients with suspected OSAHS were recruited.Those with a history of cardiovascular or cerebrovascular events, arterial hypertension, chronic obstructive pulmonary disease, diabetes mellitus and smoking were excluded.All subjects were examined by polysomnography.Subjects with an apnea-hypopnea index (AHI) ≥5 were considered to have OSAHS.They were divided into mild, moderate and severe OSAHS groups and those with an AHI<5 were accepted into the control group.The serum level of hs-CRP,a biomarker for cardiovascular disease, was measured with peripheral venous blood samples.

There were 53 males and 12 females with a mean age 44.3±12.2 years and a body mass index (BMI) <25 kg/m².The serum levels of hs-CRP were significantly higher in OSAHS patients than those of the controls (geometric mean[95% confidence interval]0.416[0.288-0.600]vs 0.749[0.559-1.003] mg/L, P<0.05).Mean levels of hs-CRP did not differ between the group with mild-to-moderate OSAHS and the control group.However, the severe OSAHS group had a higher level of hs-CRP than the control group (P=0.004).A significant positive relationship existed between hs-CRP and AHI (r=0.407, P=0.001).According to stepwise multivariate analysis, only AHI was a reliable predictor for elevated serum level of hs-CRP among all these related factors (R²=0.166, P=0.001).

The severity of OSAHS is associated with an elevated serum level of hs-CRP in non-obese patients.

To compare the speed of vaporesection of human prostatic tissue with benign prostatic hyperplasia (BPH) and depth of tissue damage using 70 and 120 W 2μm laser devices.

Fresh prostatic tissue specimens were obtained from 5 patients by open prostatectomy and divided into separate groups (70 and 120 W) based on the energy of laser output (70 and 120 W respectively).Trials were performed in acryl basin containing 0.9% saline at 37℃.And then each prostate gland in vitro was vaporesected similarly as routine transurethral 2μm laser vaporesection.70 W and 120 W power were applied for prostatic vaporesection.The 2μm laser vaporization proportion and vaporesection speed were calculated postoperatively.Prostatic tissue was embedded for histological evaluation.After hematoxylin and eosin (H&E) staining and nicotinamide adenine dinucleotide-reduced (NAD\H) measurement, depth of coagulation zone and necrotic tissue layer were measured.The results of prostatic tissue between two groups were compared.

With increasing output power, the speed (mean±SD) of vaporesection of human prostatic tissue increased from (5.21±0.66) g/5 min at 70 W to (10.84±1.23) g/5 min at 120 W.Significant differences existed in the speed of vaporesection, resection and vaporization between 120 W and 70 W devices (P=0.000).The proportion of vaporization mode was 81% at 70 W and 87% at 120 W during prostatic vaporesection.There was a stable penetration/coagulation depth with increasing power output for (0.98±0.13)/(0.30±0.09) mm at 70 W and (0.99±0.12)/(0.31±0.08) mm at 120 W.There were no significant differences in penetration and coagulation depth between 120 W and 70 W (P>0.05).

Both 120 and 70 W 2μm Laser devices yield excellent performance and security in vaporesected human prostate tissue.The 120 W 2μm laser offers significantly higher vaporesection rates than 70 W power.And vaporization mode is a predominant procedure of prostatic vaporesection.

To explore whether ultrafiltration is superior to intravenous diuretics in ameliorating fluid overload and preserving renal functions in decompensated heart failure patients.

By searching in Pubmed, Cochrane Library, Embase, Springer, WanFang, CQVIP, CNKI and CBM database as well as related Chinese journals,qualified randomized controlled trials (RCTs) were included for meta-analysis by Revman 5.0 and STATA 10.0.

Six RCTs were included with 241 patients in ultrafiltration group and 240 patients in intravenous diuretics group.Pooled analyses demonstrated ultrafiltration was superior to intravenous diuretics in the aspects of weight loss (WMD=1.44 kg, 95% CI: 0.33-2.55 kg,P=0.01) and fluid removal (WMD=1.23 kg,95% CI:0.63-1.82 kg,P<0.01) while no significant difference was observed in serum creatinine level (WMD=-5.70μmol/L, 95% CI:-35.02-23.61μmol/L,P=0.70),serum creatinine change from baseline (WMD=4.74μmol/L,95% CI:-13.72-23.20μmol/L, P=0.61), mortality (RR=1.09, 95% CI: 0.69-1.70, P=0.72) or rehospitalization (RR=0.92, 95% CI:0.53-1.61, P=0.78).

For decompensated heart failure patients, ultrafiltration is superior to intravenous diuretics in mitigating fluid overload.No intergroup difference was observed in renal function preservation, mortality or rehospitalization.

To explore the effects on the standardized management of patients with coronary atherosclerotic heart disease complicated with chronic heart failure.

A total of 823 patients discharged from our department were randomly enrolled.Among 734 patients with follow-up consents, they were divided into management and control groups (n=440, 294).The management group received standardized out-of-hospital management, regular health education and follow-ups of telephone and outpatient visits.

Compared with the control group, the management group had lower rates of all-cause mortality, cardiac death and readmission due to cardiovascular events (CVE) declining by 26.5%, 32.2% and 57.0% respectively.Over a 4-year period, the annular survival rate of management group was 92%, 85%,83% and 82% while that of control group 95%, 89%, 82% and 75% respectively.Patient compliance of digoxin and diureticum in the control group was inferior to that in the management group.

Through standardized out-of-hospital management, the patients with coronary atherosclerotic heart disease plus chronic heart failure may achieve significant benefits through reducing the rates of all-cause mortality, cardiac death and readmission due to CVE and improving survival rate.

To explore the proportion and prevention status of venous thromboembolism (VTE) among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing.

Based on a multi-center retrospective study, a total of 636 hospitalized AECOPD patients from 17 class 2/3 hospitals in Beijing were examined from September 1, 2011 to March 31, 2012.They fulfilled one of the following criteria: respiratory failure typeⅡ, on invasive or non-invasive mechanical ventilation, hospitalization for pulmonary infection, bedridden duration≥3 days and congestive heart failure.All investigators received standardized training and used a standardized questionnaire to collect data on VTE risk factors, the diagnosis of VTE and the utilization of VTE prophylaxis.According to Caprini score, they were categorized into 3 groups of lower risk (Caprini score≤3), moderate risk (Caprini score 4-6) and high risk (≥7) to compare the intergroup differences in the VTE proportion and the utilization of VTE prophylaxis.

A total of 636 patients were assessed.There were 416 males and 220 females with a mean (SD) age of 74.9±9.3 years.Among them, 133 patients received lower extremity venous ultrasonic examination and 92 were diagnosed with deep venous thrombosis (DVT) including 2 patients with pulmonary thromboembolism (PTE).Thus the overall incidence of VTE was 14.5% (92/636) and increased with age (P trend=0.044).The proportion of V TE in asymptomatic patients was higher in those symptomatic ones (21.1% vs 8.0%,P=0.000).And it was the highest in high risk group, followed by lower risk and moderate risk groups at 17.9% (14/78), 16.0% (26/163) and 13.2% (52/395) respectively, There was no statistical significance (P=0.450 for group difference, P trend=0.946).Among 544 patients without VTE, only 19.1% (104/544) employed the pharmacologic and/ or mechanical methods for preventing VTE.The prevention proportion gradually increased with rising Caprini score, i.e.17.5%, 18.4% and 26.6% for lower, moderate and higher risk group respectively.There was no statistical significance (P=0.266 for group difference, P trend=0.201).

The proportion of VTE is relatively higher.However, the preventive methods are significantly underutilized among hospitalized AECOPD patients in Beijing.

To explore the effects of low-dose radiation on the expression of immunogenic membrane molecules calreticulin (CRT) and MHC-Ⅰ/Ⅱ on the surface of human renal clear cell carcinoma 786-0 cells.

The inhibitory activity of low-dose radiation on cell line 786-0 was examined by CCK-8 assay.And the post-radiation membrane expressions of CRT, MHC-Ⅰ and MHC-Ⅱ were measured by flow cytometry while CRT was visualized by immunofluorescence photography.

The inhibition rates on the proliferative capacities of four 786-0 cell lines rose with the incremental radiation doses of 0, 6, 12 and 24 Gy.And the CRT expression levels of each experimental group was significantly higher than that of the control group (P<0.001).Along with incremental doses of irradiation, the average calreticulin fluorescence intensities increased gradually initially and then there was a downward trend.The membrane expressions of MHC-Ⅰ and MHC-Ⅱ of each experimental group was significantly higher than those of the control group (P<0.05).As the irradiation dose increased, the average MHC-Ⅰ fluorescence intensities increased gradually in a dose-dependent manner.

The low-dose radiotherapy may up-regulate CRT and MHC classⅠ/Ⅱ related with the immunogenicity of tumor cells to induce immune response against tumors.

To explore the hemagglutinin (HA), neuraminidase (NA) gene/protein evolution and the variability of antigenicity sites of influenza A (H7N9) virus.

The sequences of HA, NA gene and amino acid (AA) were downloaded from National Center for Biotechnology Information (NCBI) and the Global Initiative on Sharing All Influenza Data (GISAID) database.The bioinformatic software programs of Clustal-W, MEGA 5.0, Net NGlyc 1.0 Server and DNAMAN were employed to analyze the variations and predict the possible antigenicity sites.

A total of 26 HA gene and AA and 24 NA gene and AA sequences were analyzed. HA, NA gene and AA sequence of H7N9 virus were conservative in America but not in Eurasian area.The HA and NA gene evolutions could be divided into 2 general systems: Eurasian and America.Only one basic AAR (Arg) was close to HA cleavage sites of H7N9 virus.Regional differences existed between HA protein cleavage and NA protein glycosylation sites.And the HA glycosylation sites were conservative.Several antigenicity sites of HA and NA protein changed in Eurasian area and America.In 7 cases, novel H7N9 evolved virus isolated from China were one branch of Eurasian area.Five AAs were deleted in stalk region of NA residues 69 to 73.HA protein cleavage and glycosylation sites did not carry the variant.However, several antigenicity sites of HA and NA protein changed compared with other virus strains.

Regional differences exist in HA and NA gene evolution of H7N9 virus.The deletion of 5 AAs in stalk and the variation of several antigenicity sites of HA and NA protein may lead to an outbreak of H7N9 virus in humans.

To explore the effects of different methods of fluid resuscitation on the levels of inflammatory mediators during burn shock stage.

Twenty-four miniature swines were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin, hydroxyethyl starch, Parkland and allogeneic plasma (n=6 each).Severe burn shock model was established.Succinylatedgelatin, hydroxyethyl starch (130/0.4), Ringer′s lactate and swine allogenic plasma were used as resuscitation fluid (alternative colloid) according to the burn shock recovery principles (beginning at 2 h post-injury).The parameters of heart rate (HR), blood pressure (BP), urine volume and central venous pressure (CVP) before and within 48 h post-burn were recorded.And the levels of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β and IL-8 were measured at the time of pre-injury as well as 4 h, 8 h, 24 h and 48 h post-injury.Statistical analyses were performed.

All swines survived the shock stage.TNF-αin succinylated gelatin group was significantly higher at 48 h post-injury than that in allogeneic plasma group ((351±74) vs (215±44) ng/L, P<0.05).TNF-α in hydroxyethyl starch group was significantly higher at 8 h post-injury than that in allogeneic plasma group ((327±38) vs (249±29) ng/L, P<0.05).And they were both higher than the pre-burn levels (both P<0.05).Compared with pre-injury ((508±64) ng/ L),the level of IL-1β in succinylated gelatin group increased substantially at 4 h ((563±76) ng/L),8 h ((589±76) ng/L) and 48 h ((736±42) ng/L) post-injury (all P<0.05).The hydroxyethyl starch group was higher at 48 h post-injury than that at pre-injury ((574±72) vs (492±41) ng/L, P<0.05).Also in Parkland group, the levels were higher at 24 h and 48 h hours post-injury than that at preinjury ((575±31), (584±65) vs (498±33) ng/L, both P<0.05).Only succinylated gelatin group was significantly higher (P<0.01) at 48 h post-injury than allogeneic plasma group ((561±48) ng/L).Campared with pre-injury ((561±48) ng/L), the level of IL-8 in succinylated gelatin group increased significantly at 8 h ((1012±100) ng/L), 24 h post-burn ((993±87) ng/L), significantly higher than allogeneic plasma group ((866±99) ng/L) at 24 h (all P<0.05).Although hydroxyethyl starch and Parkland groups increased significantly at 4 h post-injury and 8 h,48 h post-injury versus those at pre-injury (all P<0.05).There was no significant difference at each timepoint compared with pre-burn (P>0.05).

The recovery regimens of hydroxyethyl starch and Parkland groups may restrain the levels of inflammatory mediators.And the effects are similar to those of allogeneic plasma group.

To explore the effects and mechanism of secretory calcitonin gene-related peptide (CGRP) and CGRP receptor modified mesenchymal stem cells on proliferation and phenotypic transformation of vascular smooth muscle cell.

Firstly (Lenti-GFP-CGRP, referred to CGRP^+/+) MSCs were transfected with high expression lentivirus vector of CGRP (MSCs^CGRP+/+).Protein secretion in the above-mentioned MSCs^CGRP+/+supernatant was detected with enzyme-linked immunosorbent assay (ELISA).And then MSCs^CGRP+/+was co-cultured with VSMCs^RAMP1+/+and VSMCs^RAMP1-/-respectively.Experimental groups were as follows: MSCs+ VSMCs MSCs^CGRP+/++ VSMCs, MSCs^CGRP+/++ VSMCs^RAMP1+/+and MSCs^CGRP+/++ VSMCs^RAMP1-/-.Flow cytometry was applied to detect the cycle variation of smooth muscle cells, thiazolyl blue tetrazolium bromide method for detecting the proliferation of smooth muscle cells and Western blot for examining the expression changes of spectrin α-SM-actin and synthetic protein OPN in each group respectively.

After the transfection of CGRP^+/+, MSCs^CGRP+/+secreted and expressed CGRP protein, the secretory volume of CGRP protein in MSCs^CGRP+/+increased significantly compared with the control group (19.530±0.498 vs 3.133±0.160 and 3.120±0.001,P<0.05).After a 72 h co-culturing with VSMCs, the proliferation of VSMCs in MSCs^CGRP+/++ VSMCs^RAMP1+/+group declined significantly (0.270±0.263 vs 0.413±0.070, P<0.05) and the number of cells staying in G0 phase significantly increased (93.51%±0.38% vs 84.48%±0.31%, P<0.05), the expression of contractile phenotype protein α-SM-actin increased and intermediate phenotype OPN declined significantly as compared with MSCsCGRP^+/++ VSMCs group {(α-SM-actin 102 946±3847 vs 51 759±635, P<0.05), OPN (26 026±2595 vs 44 201±2811, P<0.05)}| but compared with MSCs^CGRP+/++ VSMCs^RAMP1+/+ group, the proliferation of VSMCs in MSCs^CGRP+/++ VSMCs^RAMP1-/-group significantly increased (0.601±0.04 vs 0.270±0.263, P<0.05) while the number of cells staying in G0 phase significantly declined (78.57%±0.68% vs 93.51%±0.38%, P<0.05).The expression of contractile phenotype proteinα-SM-actin declined while intermediate phenotype OPN increased significantly in MSCs^CGRP+/++ VSMCs^RAMP1-/-group {α-SM-actin (34 400±2179 vs 102 946±3847, P<0.05), OPN (53 933±1192 vs 26 026±2595,P<0.05)}.

CGRP gene-modified MSCs may secrete target protein stably.And CGRP-modified MSCs inhibits VSMCs phenotypic transformation and cell proliferation.It is probably associated with enhanced CGRP effect due to an up-regulation of CGRP receptor.

To explore the effects and possible mechanism of 17β-estradiol on the expression of small conductance Ca²⁺activated K⁺channel 3 (SK3) in rat colonic smooth muscle cells (SMC).

The SMC isolated from male SD rats by enzymolysis were cultured.And double immunofluorescence staining was used to detect the co-expression of SK3 and α-actin.Colonic SMC were cultured with different concentrations of 17β-estradiol for 24 h or with 50 nmol/L 17β-estradiol at different timepoints respectively.The expressions of SK3 in colonic SMC were measured by real-time quantitative reverse transcription (qRT) -PCR and Western blotting.The effects of estrogen receptor (ER) inhibitor ICI 182780, albumin bovine serum-17β-estradiol (BSA-E2), ERαselective agonist propyl pyrazole triol (PPT) and ERβselective agonist diarylpropiolnitrile (DPN) on SK3 expression were observed.

Double immunofluorescence staining showed that SK3 andα-actin coexpressed in cultured colonic SMC.The expression of SK3 of 17β-estradiol at different concentration (10, 50 nmol/L) significantly higher than the control group (protein: 0.217±0.030 and 0.321±0.077 vs 0.103±0.063,m RNA:1.872±0.606 and 2.967±0.659 vs 0.813±0.202, all P<0.05).And 50 nmol/L was the most effective in vitro concentration.The peak expression of SK3 appeared at 12 and 24 hour (2.91 and 3.30-fold in protein vs 3.46 and 3.37-fold in mRNA respectively, all P<0.05).The protein levels of SK3 in ICI 182780 plus 17β-estradiol group was less than 17β-estradiol group (0.111±0.050 vs 0.351±0.084, P<0.05).But it was not influenced by BSA-E2.The expressions of SK3 in PPT and E2 groups were both higher than control group (0.270±0.071, 0.309±0.052 vs 0.087±0.018, both P<0.05).However DPN had no effect on SK3 protein levels.

SK3 is localized in rat colonic SMC.And 17β-estradiol increases its expression in an ERα-dependant manner.

To explore the clinical application values of five-color flow cytometry for leukocyte differential count in peripheral blood.

Leukocyte differentiation in 265 peripheral blood samples collected at Peking University First Hospital from September 2010 to December 2010 was detected by standard microscopic cytology as a reference method.Meanwhile, Beckman-Coulter LH750 hematology analyzer and FC500 flow cytometer were performed.Then the correlations were analyzed between microscopic cytology, hematology analyzer and flow cytometry.Forty blood samples collected at Peking University First Hospital, Beijing Daopei Hospital and General Hospital of Beijing Military Command from August 2010 to November 2010 were analyzed by standard microscopic cytology, Beckman-Coulter LH750 hematology analyzer and NAVIOS flow cytometer.Then the correlations between microscopy, hematology analyzer and flow cytometry were explored to analyze the clinical diagnostic efficiency of flow cytometry.

Correlation of leukocyte differential count between FC500 flow cytometer and standard microscopic cytology was significant (all P<0.01).And it was superior in the detection of lymphocytes,neutrophils and eosinaphils (r=0.955, 0.928, 0.876).Moreover, the correlation of leukocyte differential count between NAVIOS flow cytometer via manual gate and standard microscopic cytology was significant (r>0.700, all P<0.01) except for basophils.And it was superior in the detection of neutrophils, lymphocytes and blasts (r=0.950, 0.915,0.852).When 1% was set as the cut-off value of immature granulocytes on standard microscopic cytology, the sensitivity and specificity of flow cytometry was 87% and 76% respectively.When 0.5% was set as the cut-off value of blasts on standard microscopic cytology, the sensitivity and specificity of flow cytometry stood at 100% and 92% respectively.

Five-color flow cytometry is well-correlated with standard microscopic cytology for leukocyte differential count in peripheral blood with different flow cytometers,and the sensitivity of detecting blasts and immature granulocytes is very excellent.

To evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) in the treatment of middle and lower esophagus submucosal tumors (SMT) originating from muscularis propria (MP) layer.

A total number of 33 esophagus submucosal tumor (SMT) originating from MP layer underwent tumor resection by STER after endoscopic ultrasonography (EUS) and CT examination at Endoscopy Center, Department of Gastroenterology, First Affiliated Hospital, Nanjing Medical University from March 2012 to March 2013.There were 17 males and 16 females with an age range of (50±10) years.Their lesion size, lesion origin, pathology, operative duration and complication rate were analyzed.

Among them, the origins were of submucosal (n=4,12.1%), superficial muscularis propria layer (SMP)(n=18, 54.6%), deep muscularis layer (DMP)(n=10, 30.3%) and serosa (n=1, 3.0%).There were single tumor (n=30, 90.9%), double tumors (n=2,6.1%) and triple tumors (n=1,3.0%).Except for 1 case of non-resected hemangioma, 36 operative specimens were examined pathologically, including 30 leiomyomas tumors (83.3%), 5 stromal tumors (GIST) (13.9%) and 1 lipoma tumor (2.8%).Thirty-two lesions were successfully resected by STER with a complete resection rate of 97.0%.Average lesion size was (1.7±1.0) cm and average operative duration (49±26) min.A number of (7.8±2.5) hemostatic clips were used to close the mucosal incision site.Subcutaneous emphysema occurred in 3 patients (9.1%) while puncture and pneumothorax developed in one case (3.0%).All of them recovered uneventfully through conservative treatments.

As a new safe, efficacious and feasible treatment for middle and lower esophagus submucosal tumors,STER may completely resect SMT and provide accurate histopathological evaluations.And it is feasible to regain the mucosal integrity of GI tract and prevent the occurrences of leakage and secondary infections.