Volume 94  ·   Issue 24  ·  2014

Pancreatic fistula is one of the serious complications after pancreaticoduodenectomy (PD). The incidence rate of pancreatic fistula is 5% ~25%, and the mortality rate caused by pancreatic fistula is 20% ~50%^[1,2,3]。 In order to reduce or prevent the occurrence of pancreatic fistula, Peng Shuyou et al. in 1996^[3]Bundled pancreatojejunostomy (BPJ) was created, which has been widely used at home and abroad due to the remarkable efficacy of BPJ, while some shortcomings have also been reported, such as Buc^[4]Studies have concluded that BPJ may be a contraindication when the pancreatic stump is too large and does not match the size of the intestinal lumen. Therefore, over 15 years, we have successively created Binding pancreaticoastrostomy (BPG), end-to-side Binding Pancreaticojejunostomy (ESBPJ), Binding Pancreatic Duct to Mucosa Anastomosis (BDM), The system of bundling surgery was improved, and remarkable clinical results were achieved. In order to facilitate surgeons to reasonably choose the best anastomosis method according to their own experience and different individual conditions of patients, and further reduce or prevent the occurrence of pancreatic fistula, the relevant problems are explained as follows.

In August 2013, the author had the honor to go to the Swedish Medical Center in Seattle, USA for exchanges, and participated in part of the work of the general practitioner resident team of the center. I was deeply touched by the importance and efficiency of the general practitioner resident work. The general resident physician system is not only the development direction of the future medical model, but also has reference significance for the reform of China's medical system. Now talk about some views in combination with the reality of our country.

Enterobacteriaceae bacteria are the most important pathogenic bacteria in clinical bacterial infectious diseases, and the most important drug resistance mechanism of Enterobacteriaceae bacteria is the production of extended-spectrum beta-lactamases (ESBLs). ESBLs are a class of β-lactamases mediated by plasmids that can hydrolyze penicillins, oxyiminocephalosporins (including third and fourth generation cephalosporins) and monocyclic amide aztreonam, and can be inhibited by β-lactamase inhibitors. The diagnosis and early proper treatment of infections caused by ESBLs-producing Enterobacteriaceae bacteria have become important clinical issues that need to be solved urgently. Therefore, it is of great practical significance to formulate a consensus and provide clinicians with guidance that can be used for reference and have certain operability.

To explore the 50% effective dose (ED₅₀) of dexmedetomidine nasal drip in the induction of hypnosis in children during computed tomography (CT).

A total of 34 American Society of Anesthesiologists (ASA)Ⅰ-Ⅱautistic children scheduled for brain CT examination were studied. The induction was made by dexmedetomidine nasal drip and the ED₅₀ of dexmedetomidine determined by up-and down sequential experiment. When eyelash reflex became lost or Ramsay score was ≥4 in 1 hour after dosing, hypnosis was achieved. The study ended after 8 crossovers (successive "accept" and "refuse").

Among them, the ED₅₀ of dexmedetomidine was 1.76 μg/kg (95% confident interval: 1.64-1.88 μg/kg).

The ED₅₀ of dexmedetomidine nasal drip is 1.76 μg/kg in the induction of hypnosis in children

To compare the efficacies of internal fixation by elastic intramedullary nail versus conventional plate osteosynthesis in the treatment of both radius and ulna fractures in children.

A total of 84 cases were randomly divided into control and experimental groups at our department from July 2007 to 2013. The control group underwent conventional plating while the experimental group received elastic intramedullary nail. Preoperative preparations and postoperative rehabilitation protocols were similar. The operative outcomes were evaluated from pain score at Day 3 post-operation, radiology and forearm curative function, local wound healing after 2, 4, 8 weeks, 3, 6 months and 1 year.

Local wound healing time, radiology and forearm curative function had statistical significance between two groups(P<0.05). And the pain score had significant difference(P<0.01).

Elastic intramedullary nail has multiple advantages of mini-invasiveness, quicker healing and excellent function recovery in the treatment of both ulna and radius fractures in children.

To explore the indications of hemangiomas of different types by observing the clinical efficacy of oral propranolol.

For this retrospective study from October 2009 to June 2013, a total of 1 080 cases were classified into 5 types according to their clinical characteristics. There were 338 males and 742 females. Their types were telangiectasis (n=58), papular (n=424), plump (n=106), deep (n=176) and mixed (n=306). Propranolol was orally administered at a dose of 1.0 or 1.5 mg/kg daily (1.0 mg/kg for infants aged 2.5 months or under; 1.5 mg/kg for those aged 2.5 months or above). Dynamic observations of hemangioma size, texture or color change and adverse events during treatment were performed. Drug withdrawal was usually made after dosing for 1 year or under when there was a total regression of hemandiomas. The efficacy was evaluated on a 4-level scale.

Rank test results showed no significant differences between 5 types during the changes of lesions (χ²=1.738, P>0.05). Changing of lesions occurred 8.0 (3.7, 16.2) hours after dosing in telangiectasis type, whereas 6.5 (4.1, 14.3) hours in papular type, 7.0 (5.5, 12.7) hours in plump type, 7.5 (3.8, 11.3) hours in deep type and 6.5 (4.2, 13.4) hours in mixed type. After a follow-up of 6 months to 2.5 years, there were 378 grade Ⅳ case (35.00%), 574 grade Ⅲ case (53.15%), 120 grade Ⅱcases (11.11%) and 8 gradeⅠcases (0.74%). And there were significant differences between patients of different types (P<0.05). Patients of deep type had the best grade Ⅳ curative effect rate of 59.09% (104/176), then papular type of 51.25% (162/316) and telangiectasis type of 26.41% (112/424).

As a first-line treatment for hemangioma, propranolol shows excellent efficacies for patients of deep, mixed, plaque and papular types.

To explore the clinical characteristics and efficacies of interventional therapy for coronary artery involvement in Takayasu's arteritis (TA).

A total of 98 consecutive hospitalized TA patients with more than 50% diameter reduction of coronary artery by angiography were retrospectively analyzed from 2000 to 2013 at Peking Union Medical College Hospital.

Six cases(6/98, 6.1%)had coronary artery involvement of TA. All were females with an age range of 15-51(32±16) years. The manifestations included typical angina pectoris with a depression of ST segment on electrocardiogram. Among them, myocardial enzyme elevated in 5 cases and fulfilled the diagnosis of non-ST elevated myocardial infarction. Four cases had peripheral arterial involvement while another 2 cases had only coronary involvement. Coronary angiography was useful for definitive diagnosis. Coronary ostia was the most frequently involved. Five patients received successful coronary revascularization with drug-eluting stent and the symptom of angina pectoris improved. However, 1 patient developed restenosis in stent 3 months after percutaneous coronary intervention (PCI).

Coronary artery involvement in TA is not rare, especially ostia. The patients usually present with non-ST elevated myocardial infarction. PCI with drug-eluting stent may improve the symptoms, but the long-term effect should be investigated further.

To explore the relationship between hypoxic responsiveness of the patients with narcolepsy-cataplexy and their clinical features.

A total of 113 patients with narcolepsy-cataplexy (narcolepsy group) at Peking University People's Hospital from June 2007 to May 2008 and 128 gender-age matched volunteers (control group) were recruited. And their status of human leukocyte antigen (HLA)-DQB1*0602 was examined to differentiate hypercapnic and hypoxic responsiveness. Among them, 93 patients with severe hypersomnolence had hypercapnic and hypoxic responsiveness tested before and after the treatment of methylphenidate and another 20 with severe cataplexy did the same before and after the treatment of chlorimiopramine.

Compared with the control group, the narcolepsy group had depressed hypoxic responsiveness ((-0.135±0.105) vs (-0.223±0.136) L·min^-1·%SpO₂^-1, P<0.001). After the treatment of methylphenidate, sleepiness improved significantly in all 93 patients, but their low hypoxic responsiveness did not change ((-0.151±0.111) vs (-0.149±0.105) L·min^-1·%SpO₂^-1, P=0.780). After the treatment of chlorimiopramine, cataplexy also improved in 20 patients. However their low hypoxic responsiveness had no change ((-0.114±0.054) vs (-0.115±0.065) L·min^-1·%SpO₂^-1, P=0.949).

Lower hypoxic responsiveness in narcolepsy group is not related with the clinical features of disease.

To explore the relationship between disintegrin and metalloproteinase (ADAM33) gene polymorphism of bronchial asthma and its severity in Xinjiang Uygur population.

From January to December 2009, a total of 126 consecutive Uighur asthmatics with a definite diagnosis at First Affiliated Hospital of Xinjiang Medical University were assigned into intermittent mild (n=62), moderate (n=39) and severe (n=25) groups according to the severity of illness. The control group was a 1∶1 paired population from healthy subjects matched similarly with regards to gender, race, residence and age (with a difference <5 years). The ADAM33 gene polymorphisms of F+ 1, S+ 1, T1, T2 and V4 locus allele in each group were tested by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

In ADAM33, the distribution of T1, T2 and V4 locus allele in asthmatics and controls had a significant difference (χ²=8.064, P=0.018; χ²=8.013, P=0.018 and χ²=11.737, P=0.003). The distribution of allelic frequency showed that all T1 (C), T2 (A) and V4 (G) locus allele increased the relative risk degree of asthmatics (OR=2.080, 2.139 and 1.912). The distribution frequency of T1 (TC and TT), T2 (AG and GG), V4 (GG and CC) genotypes in mild, moderate and severe groups had significant differences (all P<0.05). Linkage disequilibrium analysis showed that in asthmatics, the presence of Hap2 (CATGC) was much lower than controls (20.4% vs 30.4%;χ²=6.597, P=0.010) while Hap4 (CACAC) and Hap5 (TACAG) were much higher than those in controls (9.6% vs 4.8% and 6.8% vs 2.8%; χ²=4.545, P=0.033 and χ²=4.377, P=0.036).

The ADAM33 gene polymorphism of T1, T2 and V4 locus allele may be associated with asthma and its severity in Xinjiang. And Uighur population may have both susceptible and protective haplotypes of asthmatics.

To explore the clinicopathological characteristics of gastric cancer with synchronous ovarian metastasis and the significance of expression of sex hormone receptors.

We retrospectively collected 31 cases of gastric cancer with synchronous ovarian metastasis from January 2002 to December 2012 from First and Third Affiliated Hospitals, Anhui Medical University as the test group. Then the expressions of estrogen receptor alpha (ERα), estrogen receptor beta (ERβ), progesterone receptor (PR) and androgen receptor (AR) in primary and metastatic lesions were detected by pathology and immunohistochemistry. Meanwhile 31 female gastric cancer patients without ovarian metastasis during the same period and at the same hospital designated as the control group. And their clinicopathological data were analyzed.

As compared with the control group, the primary lesions of the test group had significant differences in age, tumor gross type, pathological type, degree of differentiation, depth of tumor invasion, peritoneal implantation and vascular thrombosis (all P<0.05). The expressions of ERα, ERβ, PR and AR in primary tumors of the test group were 48.4% (n=15), 38.7% (n=12), 41.9% (n=13), 32.3% (n=10) versus 22.6% (n=7), 64.5% (n=20), 16.1% (n=5) and 41.9% (n=13) in the control group. The expressions of ERα, ERβ and PR in two groups were statistically significant(allP<0.05). The expressions of ERα and PR were positively correlated (P<0.05) while there was no correlation between the others in test group (bothP>0.05).

The strengthened expressions of ERα and PR and a missing expression of ERβ may be a crucial factor in gastric carcinogenesis with synchronous ovarian metastasis.

To evaluate the effects of neoadjuvant chemoradiotherapy on anorectal function in patients with mid and low rectal cancer.

A total of 22 patients with mid and low rectal cancer were enrolled into this study from October 2012 to November 2013. There were 14 males and 8 females with a mean age of(59±10)years. We collected the defecation-related symptoms with questionnaire interview and evaluated the anorectal function with three-dimensional high-resolution manometry before neoadjuvant chemoradiotherapy and at 6 weeks after radiotherapy.

The defecation-related symptoms (including increase in stool frequency, change in stool form, hematochezia and urgency, etc.) improved significantly after neoadjuvant chemoradiotherapy (n=21). Among those with lower rectal cancer (n=8), the length of high-pressure zone in manometry increased significantly after neoadjuvant chemoradiotherapy ((3.84±0.61)vs (2.96±0.80) cm, P=0.003). However, there was no significant change for other parameters in anorectal function(all P>0.05).

In patients with mid and low rectal cancer, neoadjuvant chemoradiotherapy may improve the defecation symptoms and enhance anal sphincter high-pressure zone for lower rectal cancer. And it is probably due to its tumor-downsizing effect.

To identify the specific antigens of the fifth stage larvae (larvaeⅤ) of Angiostrongylus cantonensis in soluble proteins.

The techniques of two-dimensional electrophoresis (2-DE) and immunoblot were employed to analyze the soluble components of larvae Ⅴ antigens. The resulting protein spots were identified by mass spectrometry and the specific antigen and immunogenic peptide segment profiles determined. LarvaeⅤwas identified by immunoblot of peptide immune murine sera.

Immunoblot of 2-DE showed that there were 8 specific antigen spots in females and 4 in males of larvae Ⅴ. The 12 protein spots had a pH range of 5-7 and a molecular weight of 24-40 kD. Among 12 spot, actin-1 and galectin-1 were identified successfully. And a peptide(NH₂-KNGDIALHFNPRFDEK) was predicted as epitope and synthesized. The binding capacity of murine immune sera could identify the 32 000 of larvae Ⅴ.

Galectin and actin are common antigens of female and male larvae Ⅴ of A. cantonensis. And a peptide from galectin-1 may become a potential target for immunologic diagnosis and immunological mediator.

To explore the role and molecular mechanism of forkhead transcription factor O1 (FoxO1) for extracellular matrix (ECM) protein accumulation in rat mesangial cells (MCs) cultured under high-glucose conditions.

The MCs were transfected with either lentiviral vectors containing the sequences of constitutively active FoxO1 (LV-CA-FoxO1) or empty vectors (LV-NC-GFP). The MCs were divided into 4 groups of normal glucose (5.6 mmol/L) (NG), high glucose (25 mmol/L) (HG), high glucose plus LV-CA-FoxO1 (LV-CA) and high-glucose plus empty lentiviral vectors (LV-NC). After 72 h treatment, the mRNA levels of MCs were measured through real-time polymerase chain reaction (PCR) in each group, including FoxO1, fibronectin (FN), collagen Ⅰ(Col Ⅰ), collagen Ⅳ (Col Ⅳ), transforming growth factor-β1 (TGF-β1), TGF-β type Ⅰand type Ⅱ receptor (TGF-βRⅠ/Ⅱ). The protein levels of FoxO1, phosphorylation FoxO1 (p-FoxO1), TGF-β1 and TGF-βRⅠ/Ⅱ were assessed by Western blot. And the distributions of TGF-βRⅠ in MCs were detected by immunofluorescence.

Expression and bioactivity changes of FoxO1: Compared with NG group, there was no significant difference in either mRNA or protein levels of FoxO1 in HG group (P>0.05) whereas the protein levels of p-FoxO1 markedly increased (P<0.05). The levels of FoxO1 mRNA and protein increased in LV-CA group versus HG group (mRNA: 17.36±1.13 vs 1.01±0.12, protein: 4.38±0.09 vs 0.93±0.10, bothP<0.05). And there was a significant decrease of p-FoxO1/FoxO1 ratio (P<0.05). Thus it suggested an enhancement in FoxO1 expression and transcriptional activity. Changes of ECM protein expression. The mRNA expression levels of FN, Col Ⅰand Col Ⅳ in HG group were elevated compared with NG group (allP<0.05) while the expressions of these indices in LV-CA group became attenuated compared with HG group (allP<0.05). Changes of TGF-β pathway activation: the expressions of TGF-β1 and TGF-βRⅠ/Ⅱboth increased in HG group (allP<0.05), but decreased in LV-CA group (allP<0.05). The results of immunofluorescence suggested that the staining of TGF-βRⅠdecreased in MCs in LV-CA group versus HG group. All indices of LV-NC group had no statistical difference with those of HG group (allP>0.05).

FoxO1 plays a pivotal role in down-regulating the activation of TGF-β pathway and thereby inhibiting the secretion of ECM.

To explore the behaviors and brain glucose metabolism in a rat hyperlipidemia model with depression from chronic unpredictable mild stress (CUMS).

A total of 30 rats were randomly divided into control (CON), high-fat diet (HFD) and double model factor (DMF) groups (n=10 each). For HFD model, a high-lipid feed was provided for 13 weeks; for DMF model, a high-lipid feed for 9 weeks was followed by CUMS for 4 weeks. Serum lipids, sucrose test and brain glucose metabolism were individually measured at baseline, before and after CUMS.

(1) Serum lipids: total cholesterol ((2.67±0.04), (2.68±0.02) mmol/L) and low density lipoprotein ((1.08±0.03), (1.06±0.01) mmol/L) of HFD and DMF groups were both significantly higher than those of CON group ((1.78±0.12), (0.79±0.04) mmol/L, all P<0.01). However, high density lipoprotein ((0.89±0.04), (0.87±0.03) mmol/L) of HFD and DMF groups was significantly lower than those of CON group ((1.08±0.22) mmol/L, allP<0.01) at week 9.(2) Sucrose test: As compared with CON group, there was no statistical significant difference in sucrose relative intake (P=0.356). However, the differences were statistically significant in relative water intake and sucrose preference (all P<0.01) at Week 9 in HFD group. At Week 13, water relative intake increased ((15.44±0.57) mg/kg,P<0.01) and sucrose relative intake and sucrose preference significantly decreased in HFD group ((30.54±0.56) mg/kg, (74.37±0.66)%, allP<0.01). As compared with CON group, CUMS gradually reduced the relative intake of sucrose solution during CUMS periods in DMY rats (allP<0.01). As compared with HFD rats, water relative intake, sucrose relative intake and sucrose preference decreased in DMF group (allP<0.01). (3) Brain glucose metabolism: On 18F-fluorodeoxyglucose micro positron emission tomography, thalamus and striatum were deactivated in HFD group at Week 13 versus Week 9 (allP<0.01). Hypothalamus and insular cortex were activated while hippocampus and entorhinal cortex deactivated after CUMS in DMY group (allP<0.01).

When hyperlipidemia and depression co-exist, there are significant changes of brain glucose metabolism in many emotion-related brain regions.

To evaluate the mechanism of interleukin-1 (IL-1) in tumorigenesis.

The miRNA expression was profiled with the Exiqon miRCURY™ LNA Array System. And the miRecords algorithm and luciferase reporter assays were employed for identifying the targets of miR-425. Cell proliferation assay was performed with CCK8. Cell apoptosis assay was performed with flow cytometry.

IL-1β induced the up-regulation of miR-425, a negative expression regulator of phosphatase and tensin homolog (PTEN). An increase in miR-425 depended upon IL-1β-induced NF-kappaB activation. Repression of PTEN by miR-425 promoted gastric cancer cell proliferation.

There is a critical role for NF-kappa B-dependent up-regulation of miR-425. And it represents a new pathway for the repression of phosphatase and tensin homolog activation and the promotion of cell survival upon IL-1β induction.

In 1977, German scholar Volker Rush first put forward the concept of microecology, that is, "microecology is ecology at the cellular or molecular level", and established the first microecology research institute, mainly studying the ecological therapy and ecological regulation of live bacterial preparations. Subsequently, Chinese scholars Kang Bai and Wei Xi further proposed that "microecology is a micro-level ecology, which is a branch of life science that studies the relationship between normal microorganisms and hosts"^[1]。 In the ecosystem of different parts of human body, intestinal micro-ecosystem, including intestinal bacteria and a few viruses, fungi and spirochetes, has become a hot spot in academic circles. The interaction of intestinal microorganisms, host mucosal barrier, nutrients and metabolites constitutes a dynamic equilibrium state, namely gut homeostasis. Once the dysbiosis of homeostasis exceeds the host's regulatory ability, it will lead to a series of diseases. In recent years, the spectrum of diseases associated with intestinal homeostasis imbalance has been expanding, and diseases such as inflammatory bowel disease, irritable bowel syndrome, antibiotic-associated enteritis, chronic liver disease, obesity, diabetes and even mental and behavioral abnormalities are closely related to it^[2,3,4]。 Understanding the composition, function, influencing factors and consequences of intestinal microecology, and making a reasonable microecological adjustment plan on this basis will help to improve the symptoms and prognosis of the above diseases.

Previous studies have found that genetic and environmental factors are associated with the onset of bronchial asthma^[1,2,3]。 Because the human genetic background is unlikely to change significantly in the short term, the regulatory role of epigenetic modification between environmental and genetic factors is particularly important. Epigenetics is nucleic acid inheritance not based on DNA difference, that is, phenotypic inheritance determined by the regulation of gene expression of the whole genome under the premise that the DNA sequence is unchanged during cell division. Non-DNA sequence information can be transmitted by mitosis or meiosis, characterized in that the genetic information can be inherited from generation to generation, the alteration of the genetic information is reversible, and the DNA nucleic acid sequence encoding the genetic information is unchanged. The epigenetic regulation of asthma occurrence includes DNA methylation, histone modification, non-coding RNA regulation, etc. Various epigenetic modifications interact and regulate each other, constituting a complete and complex epigenetic regulatory network.

Helicobacter pylori (H.pylori) is a pathogen with a high infection rate worldwide and can cause a range of gastrointestinal diseases, including chronic gastritis, peptic ulcer and gastric cancer^[1]。 althoughH.pyloriInfection can activate the host's immune system, but the body can't completely eliminate it, causing bacteria to survive in the body and continue to infect, eventually causing cells to become cancerous. The precise mechanisms remain unclear, which has becomeH.pyloriA major conundrum in prevention and treatment. Recent studies have proposed thatH.pyloriInfection can regulate cell autophagy, and this process is closely related to its pathogenicity^[2,3,4,5,6]。 Autophagy is a biological process in which cells use their own lysosomes to remove or degrade damaged organelles, misfolded proteins, and invading microorganisms^[7]。 NowH.pyloriThe regulation of autophagy by infection and its relationship with gastric carcinogenesis are reviewed.