Volume 93  ·   Issue 46  ·  2013

To explore the indications, timing and approaches of surgical interventions for severe acute pancreatitis (SAP).

A retrospective study was performed for 115 hospitalized SAP patients from 2007 to 2013.

Among them, 62 underwent surgery and another 53 were treated conservatively.The curative and mortality rates of surgical intervention and non-operation groups were 87.1% vs 84.9% (P>0.05) and 9.68% vs 9.43% (P>0.05) respectively.Twenty-five patients received early surgical intervention (<2 week) and another 37 delayed surgical intervention.The interval from diagnosis to surgical intervention of two groups were 7.5±3.3 and 23.9±8.5 days respectively.The mortality rates of early and delayed surgical groups were 16.0% and 5.4% respectively (P>0.05).

Individualized comprehensive therapy should be offered in the treatment of SAP.Timing of surgery for those with pancreatic necrosis and infection should be delayed to 3-4 weeks later until their general conditions permit.

To summarize the experiences of percutaneous cardiopulmonary support system (PCPS) for critically ill patients and examine the risk factors associated with prognosis.

The clinical data of 22 patients with acute severe cardiorespiratory failure on PCPS at intensive care unit of Zhejiang Provincial People′s Hospital from September 2006 to February 2013 were retrospectively collected and analyzed.According to the prognosis, they were divided into the survival and mortality groups.And their risk factors of prognosis were analyzed.

The PCPS support time was 2-334 (75±10) hours, 14 cases (63.6%) were successfully weaned and 12 cases (54.6%) discharged.The inter-group differences of blood lactic acid level before PCPS, heart ejection fraction,sequential organ failure assessment (SOFA) score and number of multiple organ failure (>3) were statistically significant (P<0.05).

PCPS is an effective approach for severe acute patients with cardiopulmonary failure.And blood lactic acid level before PCPS, heart ejection fraction, SOFA score and number of multiple organ failure (>3) may be the risk factors related with prognosis.

To explore the association of 12-lipoxygenase (LOX12) Arg261Gln polymorphism with the risk of hepatic carcinoma in Chinese population.

A total of 280 cases of hepatic carcinoma and 560 frequency-matched controls were recruited from January 2008 to December 2012 at Hebei United University Affiliated Hospital.The method of PCR-restriction fragment length polymorphism (RFLP) was employed to genotype LOX12 Arg261Gln polymorphism.And odds ratios (OR) and 95% confidence intervals (CI) were calculated with a model of unconditional Logistic regression.

The alleleic frequency for LOX12 Arg261Gln was significantly higher in hepatic carcinoma cases than that in controls (0.563 vs 0.437).For the control group,the three genotypes of LOX12 Arg/Arg,Arg/Gln and Gln/Gln were 24.3% (136/560),52.9% (296/560) and 22.8% (128/560) respectively.For the hepatic carcinoma group,these three genotypes were 19.1% (53/278),49.3% (137/278) and 31.6% (88/278) respectively.Logistic regression analysis showed that,compared with 261 Arg/Arg genotype carriers,the subjects with 261Gln/Gln had increased risks for hepatic carcinoma (OR=1.83,95% CI:1.18-2.84).When stratified by smoking status,the 261Gln/Gln carriers had an increased risk of developing hepatic carcinoma (OR=2.23,95% CI:1.16-4.26) among smokers, but not among non-smokers.

LOX12 Arg261Gln polymorphism is associated with the susceptibility to hepatic carcinoma.

To explore the prevalence and risk factors for abnormal plasma liver enzymes in patients with type 2 diabetes mellitus.

Overweight or obese patients with type 2 diabetes were recruited from 60 tertiary and secondary hospitals in Guangdong Province between August 2011 and March 2012.The abnormal plasma liver enzymes was diagnosed as alanine aminotransferase>40 U/L and/or aspartate aminotransferase>40 U/L.Binary Logistic regression was used to assess the associations between abnormal plasma liver enzymes and associated risk factors.

The abnormal plasma liver enzymes were detected in 709/3543 diabetics with overweight or obesity.And the prevalence of abnormal plasma liver enzymes was 20.0%.According to binary Logistic regression analysis, the presence of abnormal plasma liver enzymes was associated with male gender (OR=1.603,95% CI:1.247-2.061), higher Hb A1c (OR=1.049,95% CI:1.005-1.096), higher body mass index (OR=1.058, 95% CI: 1.014-1.103), higher waist circumference (OR=1.019,95% CI:1.006-1.032), higher triglyceride level (OR=1.053,95% CI: 1.008-1.100), adiposis hepatica (OR=1.543; 95% CI:1.244-1.914), regular exercises (OR=0.591,95% CI:0.472-0.740) and diet control (OR=0.794,95% CI:0.635-0.993).

There is a high prevalence of abnormal plasma liver enzymes in overweight/obese with diabetics.And decreasing the levels of HbA1c, body mass index, waist circumference and triglycerides, regular exercises and diet control may decrease its prevalence.

To investigate the prevalence characters of dyslipidemia and borderline dyslipidemia in aging residents from Beijing communities and to evaluate the relative risk of cardiovascular risk factor (CRF) to dyslipidemia.

The samples were selected by random cluster multistage method.Serum lipid level and CRF were determined through questionnaire, physical examination and biochemical detection for 1974 subjects who was 65 and over 65 years old in Beijing communities.

Age-and sex-adjusted standardized incidence of dyslipidemia and borderline dyslipidemia in≥65 yrs was 35.11% (693/1974) and 28.57% (564/1974) respectively, optimal lipid was 36.32% (717/1974).Vs optimal status 3 borderline factors (BF), 1 major CRF, 2 CRFs, and 3 CRFs to have dyslipidemia, the relative risks are OR=1.537,95% CI 0.597-3.959, OR=1.898,95% CI 0.993-3.628, OR=2.441,95% CI 1.268-4.698, and OR=4.256,95% CI 2.104-8.608 respectively.

The prevalence of major CRFs of≥65 yrs resident from Beijing communities are higher than the average level of China.The risk is higher while the number of borderline and major CRFs much more.

To explore the clinical characteristics and prognosis of patients with angioimmunoblastic T cell lymphoma (AITL).

The clinical features and prognostic factors of 42 cases newly diagnosed as AITL at Peking University Cancer Hospital from January 2007 to August 2012 were retrospectively analyzed.

Their median age was 59 (34-76) years.Among them,97.6% cases (41/42) belonged to Ann Arbor stageⅢ/Ⅳ,73.8% (31/42) cases presented with B symptoms,85.7% (36/42) cases had painless lymphadenopathy,52.4% (22/42) cases extranodal involvement,64.3% (27/42) cases elevated lactate dehydrogenase and 45.2% (19/42) cases elevated β2-microglobulin at diagnosis.And 40.5% (17/42) cases had 3 points of international prognostic index (IPI) score with the highest proportion.First-line chemotherapy was predominantly CHOP (cyclophosphamide,vincristine,doxorubicin,prednisolone) or CHOP-like-based and complete response was achieved in 44.7% (17/38) of them.The median follow-up time was 40 (2-106) months The 1, 2,5-year survival rates were 78%,57% and 39% respectively.Statistical analysis showed that IPI was an independent prognostic factor (P=0.009).Other factors included gender (P=0.311),age (P=0.263),with or without B symptoms (P=0.102),Ki-67 index (P=0.146) as well as the choice of first-line chemotherapy (P=0.292) each had a tendency of affecting| the survival rate,but failed to reach statistical significance.

Angioimmunoblastic T-cell lymphoma is a major type of peripheral T-cell lymphoma.Most AITL patients are elders with a late stage.The disease generally displays an aggressive clinical course and poor prognosis.

To explore the complications after radical gastrectomy in patients with gastric cancer according to Clavien-Dindo classification and examine the major risk factors for complications.

From October 2010 to June 2013,a total of 614 patients undergoing radical gastrectomy at Department of Gastric,Duodenal& Pancreatic Surgery at Hunan Provincial Tumor Hospital were divided into 2 groups according to the occurrence of complications (n=76,12.38%) or not (n=538,87.62%).Their clinicopathological data,such as age,gender,co-morbidities,surgical duration,operative blood loss volume and pathological stage were retrospectively analyzed by Logistic regression with a case-control model.

Among them,76 patients developed complications (12.38%).According to Clavien-Dindo classification,56 (9.12%),14 (2.28%),3 (0.49%) and 3 (0.49%) patients suffered stage Ⅱ, Ⅲ, Ⅳ and Ⅴ complications respectively.Comparing with the control group,the patients had a higher transfusion rate (43.42% (n=33) vs 24.16% (n=130),P<0.01) and a longer postoperative hospital stay in the complication group ((23±18) vs (14±6) days, P<0.01). There was no difference in age,gender,body mass index (BMI),number of dissected lymph node,levels of hemoglobin and albumin at admission,intraoperative hemorrhage,surgical duration and pathological TNM stage in two groups (all P>0.05).Univariate analysis revealed that BMI>25 kg/m², co-morbidities,diabetes mellitus,complications due to gastric cancer,hemoglobin<100 g/L, albumin<30 g/L,ascites,total gastrectomy,combined multi-organ resection,surgical duration>240 min and perioperative transfusion were associated with postoperative complications (all P<0.05).Further multivariate analysis showed that perioperative transfusion (OR=2.78,95% CI: 1.42-5.43,P<0.01) and combined multi-organ resection (OR=1.72,95% CI: 1.14-2.58,P=0.01) were independent risk factors for postoperative complications after radical gastrectomy.

Classifying the complications after radical gastrectomy according to Clavien-Dindo classification is important for comparisons and quality assessments among different studies.And decreasing perioperative transfusion and avoiding combined multi-organ resection may reduce the incidence of postoperative complications and shorten the length of hospital stay.

To explore the survival status after treatment for patients with different molecular subtypes of breast cancers.

A total of 4491 patients with invasive breast cancer from January 2000 to July 2011 were retrospectively recruited to receive pathological verification and treatment at our clinic.According to the immunohistochemical results of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2), they were assigned into 3 groups of HR+/HER2-, HER2+ and HR-/HER2-.Survival analyses were conducted to examine the effects of molecular subtypes and lymph node status on survival.

The 3-year recurrence free survival for HR+/HER2-, HER2+ and HR-/HER2-were 94.9%, 89.5% ane 92.3% respectively.Different molecular subtypes presented different survival patterns (P=0.0001).The 3-year recurrence-free survival (RFS) for LN+ and LN-was 87.1% and 97.8% respectively.And statistical difference existed (P<0.01).No difference was detected among three molecular subtypes of LN- (P=0.102) ; However, for LN+ patients, HR+/HER2- showed a higher RFS than HER2+ and HR-/HER2 (P=0.001).

Different molecular subtypes of breast cancers have varying survival.And lymph node status is probably an important prognostic factor.

To explore the association between different epidermal growth factor receptor (EGFR) mutation status and survival in pemetrexed-based chemotherapy for advanced nonsmall-cell lung cancer (NSCLC).

A retrospective cohort study was performed to assess 146 patients with advanced NSCLC at Cancer Institute/Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.The first-line regimens included pemetrexed based chemotherapy (pemetrexed first-line therapy group,n=79), pemetrexed based chemotherapy plus pemetrexed maintenance chemotherapy (pemetrexed maintenance therapy group,n=38) and pemetrexed based chemotherapy plus tyrosine kinase inhibitors (TKI) maintenance therapy (TKI maintenance therapy group,n=29).Median progression-free survival (PFS) was determined.For comparison,median PFS was evaluated for EGFR-positive,EGFR-negative versus EGFR mutation unknown NSCLC patients in first-line pemetrexed therapy and pemetrexed maintenance therapy groups.

The median PFS was 4.6 (95% CI:2.8-6.4),9.8 (95% CI:6.1-13.5) and 14.5 (95% CI:11.8-17.2) months in pemetrexed first-line therapy,pemetrexed maintenance therapy and TKI maintenance therapy groups respectively (P=0.000).No difference existed in PFS for pemetrexed first-line therapy group with a median PFS of 5.2 (95% CI: 2.8-7.7),4.0 (95% CI: 0-10.8) and 4.6 (95% CI: 3.4-5.8) months respectively (P=0.661).Among EGFR-positive,EGFR-negative and EGFR mutation status unknown patients in pemetrexed maintenance therapy group,the median PFS was 8.5 (95% CI:4.0-13.1),12.6 (95% CI: 11.6-13.7) and 8.0 (95% CI: 5.8-10.3) months with no significant statistical difference (P=0.468).

No significant difference exists in survival between different EGFR mutation status for pemetrexed based first-line chemotherapy.And TKI maintenance therapy is associated with better survival than pemetrexed maintenance therapy regardless of EGFR status.

To explore the clinical characteristics of patients with obstructive sleep apnea syndrome (OSAS) and nocturnal arrhythmia.

During September 2010 to August 2011,a total of 446 subjects were recruited from Department of Sleep Breathing Disorder,Third Hospital,Hebei Medical University to receive polysomnography examination and electrocardiogram monitoring.According to the results,they were classified as mild (5≤AHI<15/h) or moderate (15≤AHI<40/h) or severe (AHI≥40/h) OSAS.Then the incidence of different types of arrhythmias,risk factors and the relationship with OSAS severity were examined.

Among 446 patients,the incidence of arrhythmia was 24.4% (109/446).The severity of OSAS (r=1.857,P=0.043) and age (r=1.030,P=0.003) had a positive relationship with the incidence of arrhythmias.Sinus bradycardia (79.8%,87/109) and accidental ventricular premature beat (54.1%,59/109) were most likely to occur than other types of arrhythmias (P<0.01).In moderate and severity OSAS patients,the incidence of sinus bradycardia, frequent atrial premature beat, combined over two kinds of arrhythmias,atrial fibrillation and atrioventricular block were 50.0%,0,42.9%,7.1%,0 and 90.9%, 14.8%,57.9%,4.5%,5.7% respectively.And they were significantly higher than those of mild patients (all=0)(all P<0.05).

Age and severity of OSAS have a positive relationship with the incidence of nocturnal arrhythmias.Sinus bradycardia and ventricular premature beat are the most likely to occur in OSAS patients.In moderate and severe group,sinus bradycardia,frequent atrial premature beat,combined over two kinds of arrhythmias,atrial fibrillation and atrioventricular block are more commonly encountered.

To explore the change of plasma heat shock protein 70 (HSP70) in rats exposed to acute gastric mucosal injury under the condition of positive acceleration (+ Gz) and elucidate the effects of glutathione (GSH) and the corresponding protective mechanisms.

A total of 40 male SD rats were randomly by computer randomization into 4 groups of ethanol control,+5 Gz value exposure,+10 Gz value exposure and GSH protection (n=10 each).GSH protection group received adaptive feeding for 7 days and then an intraperitoneal injection of GSH for 3 consecutive days.All 4 groups fasted for 24 hours within 10 days,water deprivation for 12 hours and a gastric lavage of anhydrous ethanol (0.4 ml/100 g) for 1 hour,ethanol control group had no acceleration, +5 Gz value exposure group at +5 Gz and the latter two groups respectively at +10 Gz for around 3 min.Each group underwent anesthesia of pentobarbital after centrifuge immediately.Abdominal aortic blood samples were collected and gastric tissues harvested for observation of mucosal injury.Mucosal damage index was calculated by the GUTH method.And the plasma content of HSP70 was measured by radioimmunoassay.

(1) Gastric mucosa of each groups rats were injured.Damage was significantly reduced by GSH pretreatment,ethanol control group had less injury,the injury of+ 5 Gz value exposure group was aggravated compared with the control group (gastric mucosal injury index:25.4 (14.0-30.0) vs 10.0 (9.2-13.9),P=0.001);+10 Gz value exposure group mucosal injury was heaviest (47.2 (41.5-60.1)).There were diffuse hyperemia,edema and erosion with a large area of bleeding spots and flat mucosal folds.It had statistically significant differences with the first two groups (all P<0.01); GSH protection group was lightest at 9.5 (7.5-14.1).Compared with the +10 Gz value exposure group,mucosal damage was milder (P<0.01). (2) The plasma levels of HSP70 of +5 Gz value exposure had no significant differences with the control and ethanol groups ((6.5±0.5) ng/ml,P=0.897); HSP70 plasma level ((5.9±0.5) ng/ml) of +10 Gz value exposure was significantly lower than those of the first two groups (P=0.018,0.014); GSH protection group ((7.0±0.5) ng/ml) was significantly higher than the level of+ 10 Gz value exposure group (P<0.01).

+Gz exposure may cause the altered levels of plasma HSP70.High+ Gz value exposure reduces its content and aggravates gastric mucosal injury.And glutathione reduces the injury of gastric mucosa through elevated plasma HSP70.

To explore the regulation of insulin sensitivity in liver cells by androgen signaling.

Eleven adult female C57BL/6 mice were injected daily with testosterone (group T) for 24 weeks.And 10 control mice received sesame oil only (group Con).HepG2 liver cells were initially pretreated with different doses of testosterone (10^-9-10^-5mol/L) for 0-36 h or with 10^-7mol/L testosterone for 0-96 h followed by a stimulation of 100 nmol/L insulin for 15 min.Later HepG2 cells were pretreated with 10^-7mol/L testosterone for 36 h followed by a stimulation of 100 nmol/L insulin for 15 min and then a restimulation of 100 nmol/L insulin for 15 min at 4 h and 6 h interval respectively.Phosphorylation and protein expression of Akt and GSK3βin C57BL/6 mice liver tissues and Hep G2 cells were analyzed by Western blot.

The 24-week treatment of testosterone decreased the phosphorylation of Akt and GSK3βin C57BL/6 adipose and liver tissues (43.1%±3.2% vs 77.1%±6.7%, 14.7%±6.7% vs 82.3%±2.0% respectively, P<0.05).Pretreatment with 10^-8-10^-6mol/L testosterone within 36 h obviously increased the phosphorylation of Akt and GSK3β (P<0.05).However pretreatment with 10^-5mol/L within 36 h or with 10^-7mol/L for 96 h had no effect on the phosphorylation of Akt and GSK3βcompared with control group (P>0.05).Pretreatment with 10-7 mol/L testosterone for 36 h followed by insulin stimulation and restimulation after 6 h interval obviously decreased the phosphorylation of Akt and GSK3β (P<0.05).

Androgen signaling may contribute to insulin resistance in liver cells.

To explore the correlations of integrons, gene cassettes and drug resistance phenotypes in 90 multi-drug resistant Gram-negative bacteria.

ClassⅠ/Ⅱ/Ⅲintegron and variable region of positive strains of 90 Gram-negative bacteria were amplified by PCR and types of integron variable region gene cassettes analyzed by DNA sequence.And the resistant rates of integron positive and negative strains were tested by drug susceptibility.

The detection rate of integron was 81.1% (73/90) in 90 Gram-negative bacteria.The integron types were classⅠ (n=70),classⅡ (n=3) and classⅢ (n=0).Based on the BLAST analysis by GenBank database,in the amplified fragments of ClassⅠintegron positive strains variable region gene ranging from 730 to 3300 bp,8 types of integron structure were identified.And there were aad B (n=11),aac (6′) -Ⅱ (n=7), aad A5 (n=10),dfr A17-aadA5 (n=14),dfr A12-OrfF-aadA2 (n=1),aac A4-catB8-aad A1 (n=24), aacC1-Orf A-OrfB-aad A1 (n=3),catB3-aad B-dhfr V-aac A4-nit1-nit2 (n=1),inwhich catB3-aad Bdhfr V-aac A4-nit1-nit2 was a new resistance gene cassette| the variable region fragment of classⅡ integron positive strain was 1600 bp,with 3 carrier strains of sat2-aad A1 gene cassette.Susceptibility testing showed that the antimicrobial resistance rate of integron positive strains to aminoglycosides and sulfa were significantly higher than those of integron negative strains and accorded with the results of integration variable region gene cassettes| the positive strains were more sensitive to amikacin with a resistance rate of 32.9% (24/73) |and the drug resistance rates of all beta-lactam strains were≥80%.

There is a higher carrier rates of classⅠintegron in Gram-negative bacteria.And the resistant phenotype is related with the types of resistance gene cassettes of integron variable region.

To detect the anxiety and depression status of BALB/c asthmatic model in mice.

A total of 20 mice were randomly divided into asthma and control groups (n=10 each).The animals were sensitized and challenged with ovalbumin for asthmatic model.Phosphate buffer solution was used in the control group.The mice were challenged with increasing concentrations of methacholine aerosol and the airway resistance was measuring noninvasively by enhanced pause (Penh).And elevated plus maze test system and forced swim were employed to evaluate their anxiety and depression status.Then bronchoalveolar lavage cytology was detected for evaluating the airway inflammation.

In both groups,Penh value increased with the rising concentration of methacholine.The Penh values of asthmatic mice exciting with normal saline and methacholine concentration of 0,5 g/L were 0.43±0.04,0.41±0.05 and 0.44±0.04 versus 0.42±0.03,0.39±0.03,0.43±0.04 in control group.The difference had no statistical significance (P=0.290,0.652,0.723).At the concentration of methacholine 10,15,20 g/L,the Penh values of asthmatic mice were 0.57±0.03,0.85±0.04,1.57±0.08 and they were significantly higher than those of control group (0.45±0.08,0.57±0.06,0.82±0.09)(P=0.001,0.000,0.000).Asthmatic mice in the elevated plus maze on a behavioral test and found that asthmatic mice open arm entries sum closed arm entries (OE+CE),percent of open arm/total entries (OE%) and percent of open arm/total time (OT%) was (18.3±3.6) times, (22.2±3.1)%, (16.7±4.2)%.They were significantly lower than those of control group ((24.0±2.9) times, (28.0±3.4)%, (21.8±4.6)%)(P=0.001,0.001,0.019).Asthmatic mice swimming time was significantly higher than that of control group (147±12) vs (133±10) s (P=0.010).The total number of cells and eosinophil ratio in asthma group was (10.0±4.0) ×10⁵/ml and (68.18±3.76)%.And they were significantly larger than those of control group ((1.7±0.4) ×10⁵/ml, (0.12±0.07)%)(both P=0.000).

Asthmatic mice with concurrent anxiety and depression may be a model for elucidating the molecular mechanisms of asthma with anxiety and depression.