Volume 99 ·  Issue 06 ·  2019

The second conclusion of the Chinese and English abstract of the article "Clinical significance of FBI-1 expression before and after neoadjuvant chemotherapy for breast cancer" in Volume 98, Issue 46, 2018:P=0.027 changed toP=0.019； Results 25 cases (56.0%) of PR and 14 cases (20.0%) of SD were changed to "25 cases (50.0%) of PR and 14 cases (28.0%) of SD". I would like to apologize to the readers!

Sleep and wakefulness are very different physiological states, and one third of life is spent in sleep. Weakened respiratory central drive and reduced ventilation during sleep will have adverse effects on common respiratory diseases including chronic obstructive pulmonary disease, bronchial asthma and respiratory insufficiency. These patients can seriously affect prognosis when combined with other sleep disorders of breathing (SDB). It is necessary to strengthen awareness of such problems, actively carry out sleep monitoring, and non-invasive ventilation intervention if necessary.

Urinary stones are a common disease. The incidence rate of urinary stones in adults in China is about 6%, and it is as high as 8.85% in southern China. More than 99% of them are kidney stones and ureteral stones. In recent years, flexible ureteroscopic lithotripsy (RIRS) has been extensively carried out for stones below 2 cm. Compared with percutaneous nephrolithotripsy (PNL), RIRS has a similar stone clearance rate, but is safer, and shows some therapeutic potential for kidney stones>2 cm and even staghorn stones. Although flexible ureteroscopy is less invasive, various complications may still occur, which should be paid great attention by clinical medical and nursing.

Lung cancer is one of the malignant tumors that threatens the health and life of the population. Sleep is defined as a natural and rhythmic state of rest of the mind and body that is necessary for human health and survival. Any sleep disorder will affect the normal physiological activities of the human body, lead to the occurrence and aggravation of the disease, and in severe cases will endanger the survival of the patient. The problems of sleep disorders and breathing disorders during sleep in lung cancer patients are widespread, and their existence and harm are far from being paid attention by clinicians and researchers.

Decreased sleep quality in patients with chronic obstructive pulmonary disease (COPD), and nocturnal hypoxia with/without hypercapnia are sleep-related respiratory disorders, which should be paid attention to. COPD is easily combined with obstructive sleep apnea. When both coexist, some symptoms of patients are easily masked by one of the diseases, and the diagnosis is difficult. Clinically, the condition should be carefully questioned, and appropriate treatment should be identified and given as soon as possible to improve the prognosis of patients.

Clinically, the coexistence of asthma and obstructive sleep apnea (OSA) is becoming more and more common. The two interact with common factors such as obesity, upper respiratory tract disease, and gastroesophageal reflux to promote the development of the disease. The mechanism and clinical diagnosis and treatment of the coexistence of asthma and OSA are described in this paper.

In recent years, sleep problems in patients with idiopathic pulmonary fibrosis (IPF) have gained increasing attention. Patients with IPF have reduced total sleep time, reduced sleep efficiency, shallow and rapid breathing pattern during sleep, and hypoxemia. If it coexists with obstructive sleep apnea (OSA), the harm is superimposed. As an important comorbid disease of IPF, OSA needs to be treated simultaneously, which benefits IPF patients. This article expounds some new understandings about the clinical diagnosis and treatment of idiopathic pulmonary fibrosis combined with obstructive sleep apnea.

To investigate the effect of G protein-coupled estrogen receptor (GPER) on proliferation and autophagy in prostatic epithelial cells.

Cell Counting Kit-8 (CCK8) assay was used to observe the growth of BPH-1 and RWPE-1 cells after treating with or not with estradiol or GPER selective agonist G1. Autophagy was quantified with Western blot and Cyto-ID autophagy detection kit after treating with estradiol, G1 or both G1 and G15 in the same cells.

The OD value in estrogen group and G1 group was significantly lower than those in control group (P<0.01). Compared with control group, Western blot and Cyto-ID green reagent staining revealed that the ratio of LC3Ⅱ/LC3Ⅰ and the relative fluorescence intensity of BPH-1 and RWPE-1 cells were decreased in G1 group and estradiol group (P<0.01). Pretreatment with G15 reversed the effect of G1 (P<0.05).

The activation of GPER leads to the inhibition of autophagy and cell proliferation.

To compare the efficiency and safety of thulium laser resection of the prostate-tangerine technique (TmLRP-TT) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) of various sizes.

Clinical data of 249 BPH patients received TmLRP-TT or TURP were retrospectively collected. Patients were divided into small prostate group [prostate volume (PV)<40 ml], medium prostate group (40 ml≤PV<80 ml) and large prostate group (PV ≥ 80 ml) based on transrectal ultrasound (TRUS) results. Age, PV, Prostate-specific antigen (PSA), International prostate symptom score (IPSS), Quality of life (QoL), maximum of flow rate (Q_max) and post-void residual urine (PVR) of patients received TmLRP-TT or TURP in each group were analyzed, as well as the perioperative data including operation time, hemoglobin and serum sodium level, transfusion, postoperative length of indwelling catheter and postoperative hospital stay. Furthermore, the postoperative complication rates of patients received the two operative methods in each group up to follow-up of 6 months were compared.

As for baseline indicators, there were no significant differences regarding age, prostate volume, PSA, IPSS, QoL, Qmax and PVR of patients received TmLRP-TT or TURP in each group (all P>0.05). In the small prostate group, there were no significant differences with operation time, hemoglobin and serum sodium level, transfusion, postoperative length of indwelling catheter and postoperative hospital stay received TmLRP-TT or TURP (all P>0.05). For the medium prostate group, patients received TmLRP-TT underwent longer operation time [(67.4±15.1) vs (57.5±11.5) min, P<0.001], but shorter length of indwelling catheter [(1.5±0.6) vs (3.1±0.9) d, P<0.001] and postoperative hospital stay [(3.5±0.9) vs (5.6±1.0) d, P<0.001], and there were no significant differences regarding transfusion rate (3/73 vs 1/78, P=0.280), hemoglobin [(9.8±9.0) vs (12.2±9.6) g/L, P=0.107] and serum sodium decrease [(2.07±3.65) vs (2.97±3.35) mmol/L, P=0.373]. In the large prostate group, patients received TmLRP-TT also underwent longer operation time [(86.5±14.3) vs (76.7±14.6) min, P=0.022], but less hemoglobin [(11.3±13.8) vs (23.3±15.0) g/L, P=0.006] and serum sodium decrease [(2.41±2.67) vs (4.00±6.22) mmol/L, P=0.042], lower transfusion rate (5/27 vs 0/24, P=0.026), and shorter length of indwelling catheter [(1.8±0.7) vs (4.3±1.5) d, P<0.001] as well as postoperative hospital stay [(3.7±1.1) vs (6.1±1.7) d, P<0.001]. Less overall complications were encountered in the medium (38/73 vs 24/78, P=0.008) and large (26/27 vs 10/24, P<0.001) prostate group who received TmLRP-TT, which was not seen in the small prostate group (P=0.589).

TmLRP-TT and TURP are similarly efficient for the treatment of BPH of various sizes. For BPH patients with medium and large prostate, TmLRP-TT demonstrated significant advantages in reducing the overall complications, although the operation time was slightly longer.

To assess the complications of transperineal template-guided prostate mapping biopsy (TTMB).

Between May 2017 and March 2018, 142 consecutive patients with prior negative transrectal biopsy results and persistently elevated prostate-specific antigen (PSA) were divided into the observation group and the control group randomly. The observation group underwent TTMB and the control group underwent transperineal template-guided prostate saturation biopsy (TTSB). Bleeding, infection, urinary function were recorded after prostate biopsy. Erectile function (ED) was measured at baseline, 1 month, 3 months and 6 months after prostate biopsy using the International Index of Erectile Function (IIEF-5).

A mean of 59 cores (from 33 to 116 cores) were obtained in TTMB, and a mean of 23 cores (from 11 to 44 cores) were obtained in TTSB. The positive rate was 50.0% (30/60) in TTMB, and 32.9% (27/82) in TTSB, and there were significant differences between two groups (P<0.05). The incidence of severe hematuria and urinary retention was 8.3% (5/60) and 11.7% (7/60) respectively in TTMB, while 1.2% (1/60) and 11.7% (7/60) respectively in TTSB. There were significant differences between two groups (P<0.05). But there were no significant differences between two groups in the incidence of mild, moderate and total hematuria, hematospermia, perineal hematoma, infection (P>0.05). Rectal bleeding was not observed. In TTMB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.1±4.5), (17.4±4.8), (18.6±4.5), (19.0±4.0), respectively. In TTSB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.7±4.3), (18.2±4.5), (19.1±4.1), (19.6±4.2), respectively. There were significant differences between baseline and 1 month after prostate biopsy in two groups (P<0.05), but there were no significant differences of IIEF-5 score between the two groups (P>0.05).

TTMB can improve the positive rate for patients with prior negative transrectal biopsy results and persistently elevated PSA. TTMB has low complication rates, and most side-effects are self-limited. Compared with TTSB, the incidence of urinary retention and severe hematuria increases, but they can be recovered after clinical intervention. ED is transient, and affected for 1 month after the biopsy, but it will be recovered to the baseline after 3 to 6 months. Therefore, TTMB is a safe and reliable procedure.

To study the procedure of CYP21A2 gene mutation detection in 21-hydroxylase deficiency (21-OHD) patients.

The detail clinical and biochemical data of 51 patients with 21-OHD [18 males and 33 females, with an average age of (16.4±9.9) years] were collected between December 2016 and December 2017 at Department of Endocrinology, Peking Union Medical College Hospital. Multiplex ligation dependent probe amplification (MLPA) and Sanger sequencing of the CYP21A2 gene were used to clarify the cause of 21-OHD. The genotype-phenotype correlation was also analyzed.

The incidences of large deletion, 8 bp deletion, I2G, I172N and F306+T were 19.6% (20/102), 1.0% (1/102), 30.4% (31/102), 25.5% (26/102) and 1.0%(1/102), respectively, and the detection rate of gene mutation in 51 21-OHD patients was 77.5% (79/102) by MLPA test. Except large and 8 bp deletion, all above mutations contained in MLPA and other 8 mutations, including P31L, Q319X, R361L, R357W, V282L, R484Q, G425S and R342W were detected, and the detection rate was 79.4% (81/102) by Sanger sequencing of CYP21A2. MLPA combined with direct sequencing identified mutations in all patients. Genotype correlated well with clinical phenotype in 21-OHD patients.

When MLPA or CYP21A2 gene sequencing were used alone to diagnose the cause of 21-OHD, gene mutations in all patients could not be detected. The combination of the two methods can complement each other and fully clarify the underlying causes of 21-OHD.

To reduce the occurrence of adverse events of clinical blood use by analyzing the clinical adverse events of blood use except for the adverse reactions of blood transfusion.

A retrospective analysis was performed on 294 cases of adverse events of clinical blood use other than adverse blood transfusion reactions in Shijitan hospital from January 2014 to December 2017, and a statistical analysis was made on the types of adverse events of clinical blood use, blood transfusion related departments, and internal and surgical blood use.

The incidence of adverse events of clinical blood use was 10.3‰, 9.6‰, 4.2‰ and 4.6‰ in these 4 years respectively, and there were 216 cases (73.5%) of external departments, 49 cases (16.7%) of internal departments, 8 cases (2.7%) of nursing departments, and 21 cases of others(7.1%), which includes 12 cases of errand department, 4 cases of the clinical laboratory and 5 cases of transfusion department. The adverse events of clinical blood use were divided into 4 types: 71 cases (24.1%) of transfusion process problems, 36 cases (12.2%) of clinical communication between departments, 182 cases (61.9%) of clinical unreasonable transfusion and 5 others (1.8%). There were statistically significant differences in the occurrence of adverse events of different types of blood use in external and internal departments based on the property of the department, among which there were significant differences in unreasonable transfusion between them. According to the purpose of blood use, there were statistically significant differences in the occurrence of different types of adverse events between the two departments, and the incidence of different types of external departments were higher than that of internal departments.

The incidence of adverse events of blood use in external departments is higher than that in internal departments. Reasonable transfusion should be strengthened to avoid the occurrence of adverse events of clinical blood use, so as to ensure the safety of blood transfusion.

To observe the changes of intestinal barrier function in patients with acute severe organophosphorus pesticide poisoning (ASOPP) and the effect of early enteral nutrition on them.

A single-center, single-sample, prospective, randomized controlled clinical trial was conducted. A total of 50 patients with ASOPP were divided into 24 h enteral nutrition group (group A) and 48 h (48-72 h) enteral nutrition group (B group) according to the order of hospitalization. The two groups received equal calorie nutritional support, and Serum D-lactic acid (D-LA) and serum human diamine oxidase (DAO) were detected immediately after admission and at 48 h, 72 h and 144 h. At the same time, the worst value of APACHE-Ⅱ score was recorded, and the correlation between DAO, D-LA and APACHE-Ⅱ score was analyzed. The serum concentration of D-LA and DAO in 15 healthy adults were detected as healthy control group.

There was no statistical difference in gender, age, poisoning time and organophosphorus pesticide components between group A and B (P>0.05). The distribution of D-LA concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (66±19) μg/L, (68±21) μg/L, (66±19) μg/L, (63±17) μg/L, while in group B they were (62±15) μg/L, (58±17) μg/L, (58±16) μg/L, (67±9) μg/L. There was no statistical difference between the two groups in D-LA concentration and that of healthy people [(67±17) μg/L, P>0.05]. The distribution of DAO concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (2.1±0.6) μg/ml, (2.1±0.5) μg/ml, (2.2±0.4) μg/ml, (2.2±0.5) μg/ml, while in group B they were (2.1±0.5) μg/ml, (2.1±0.5) μg/ml, (2.2±0.5) μg/ml, (2.1±0.4) μg/ml. DAO concentration in the early stage of the intoxication of the two groups were higher than that of healthy people (0.1±0.0 μg/ml) ( P<0.05). There is no statistical difference in DAO concentration between group A and B at different time points (P>0.05). The APACHEE-Ⅱ score of 48 hours and 72 hours in group A (12.2+1.7, 5.5+2.1) was significantly lower than that in group B (14.1+2.4, 8.2+2.6) (P<0.05). D-LA, DAO concentration at different time points was not correlated with APACHE-Ⅱ score (P>0.05). D-LA (r, P) was immediate admission (-0.17, 0.24), 48 h (0.04, 0.79), 72 h (0.32, 0.06), 144 h (0.29, 0.07), and DAO (r, P) was immediate admission (-0.12, 0.43), 48 h (0.02, 0.92), 72 h (0.03, 0.85), 144 h (0.03, 0.82).

Patients with ASOPP may have obvious injury at intestinal mucosa at early stage (144 h), but the intestinal permeability is normal. Early enteral nutrition therapy can promote the recovery of patients, but has low correlation with intestinal barrier function improvement.

To evaluate the changes of rat renal function and cardiac function after transabdominal subtotal nephrectomy (STNx) and provide an ideal animal model for the study of chronic kidney disease (CKD) and cardiorenal syndrome (CRS).

The SD rats (male, 5-6 weeks) were randomly divided into Sham group (n=10) and STNx group (n=10). The rats from Sham group underwent sham surgery, and the right nephrectomy plus the 2/3 left kidney artery ligation through abdominal incision were performed in the rats from STNx group. Twelve weeks after operation, the rat serum creatinine and renal pathology were examined, the size and fibrosis of cardiac cells were also observed, after the changes of cardiac function being detected by echocardiography.

Twelve weeks after the operation, STNx group rats were generally in poor condition, with a emaciated body, absorption of the renal infarct tissue, uneven surface, and residual renal tissue compensatory hypertrophy. The serum creatinine in Sham group and STNx group was (22.10±1.64) μmol/L and (52.80±3.34) μmol/L, respectively, and there was a statistically significant difference between the two groups ( P<0.001). Compared with Sham group, the echocardiography results demonstrated that the thickness of left ventricular wall of rats from STNx group increased, the left ventricular volume decreased, and the diastolic and systolic function of left ventricular descended. The HE staining showed that the glomerulus, tubules and interstitial renal morphology were normal in Sham group, and glomerular sclerosis was observed in STNx group. And the Masson staining declared that the renal fibrous tissue distribution was normal in Sham group, and severe renal interstitial fibrosis was observed in STNx group. The wheat germ agglutinin (WGA) staining of myocardial tissue showed that myocardial cells in STNx group were larger than those in Sham group (1.293±0.060 vs 1.000±0.059, P<0.001). Moreover, the HE staining showed that there was partial myocardial tissue necrosis and fibrosis in STNx group, and severe myocardial fibrosis was observed in STNx group by Masson staining.

Similar pathophysiological changes in human CKD were observed in the rats CKD model by transabdominal STNx, and the cardiac effects of this model make it an ideal choice to study CRS.

To evaluate the effects of penehyclidine hydrochloride on the nuclear factor erythroid 2-related factor 2/antioxidant responsive element (Nrf2/ARE) signaling pathway during endotoxin-induced acute lung injury(ALI) in neonate rats.

Forty 7-day-old Wistar rats weighing 12-18 g were randomly divided into 4 groups (n=10) using a random number table: normal saline group(NS group), acute lung injury(ALI group), penehyclidine hydrochloride group(PHC group) and penehyclidine hydrochloride+ Nrf2 siRNA plasmid group(PNS group). The ALI model was induced with intraperitoneal endotoxin (5.0 mg/kg) in groups ALI, PHC and PNS. In groups PHC and PNS, penehyclidine hydrochloride (2.0 mg/kg) was injected intraperitoneally at 1 h before ALI respectively, while the equal volume of normal saline was administered in groups NS and ALI. The animal of PNS group were inhaled adenovirus packaging of Nrf2-siRNA three times (one time a day) before modeling. At 4 h after endotoxin injection, the rats were sacrificed. The lungs were collected to determine the wet/dry(W/D) lung weight ratio. The expression of Nrf2 and heme oxygen and enzyme 1(HO-1) were determined by Western blotting, contents of tumor necrosis factor-alpha(TNF-α),interleukin10 (IL-10)were determined by enzyme-linked immunosorbent assay(ELISA). The cell apoptosis were determined by transferase-mediated deoxyuridine triphosphate-biotin nick end labeling(TUNEL),and the apoptotic index was calculated.

The W/D ratio in NS, ALI, PHC and PNS groups were (4.2±0.1), (9.6±0.7), (6.5±0.6), (8.3±1.3) respectively. The apoptotic index were (3.7±0.5)%, (31.5±3.2)%, (17.6±4.2)%, (28.1±3.5)%respectively.The contents of TNF-α were (10.3±1.6), (98.5±8.5), (68.5±6.7), (89.9±8.5) pg/ml respectively. The contents of IL-10 were (7.9±0.6), (102.8±9.3), (72.5±5.8), (97.7±9.1) pg/ml respectively.The expression of Nrf2 were (23.2±7.6), (79.8±13.0), (155.5±16.7), (12.0±3.3) respectively. The expression of HO-1 were (31.7±8.6), (90.8±10.3), (147.6±22.5), (61.4±9.7) respectively. There were statistically significant differences among different groups (F=86.013, 154.897, 328.810, 374.198, 333.965, 125.274, all P<0.05). Compared with group NS, the W/D ratio, apoptotic index and the contents of TNF-α, IL-10 increased, the expression of Nrf2 and HO-1 up-regulated in group ALI and group PHC (allP<0.05). Compared with group ALI, the W/D ratio, apoptotic index and the contents of TNF-α, IL-10 decreased, the expression of Nrf2 and HO-1 up-regulated in group PHC (allP<0.05). Compared with group ALI, no significant differences were found in the W/D ratio, apoptotic index and the contents of TNF-α, IL-10 in group PNS(allP>0.05), while the expression of Nrf2 and HO-1 down-regulated in group PNS (all P<0.05). Compared with group PHC, the W/D ratio,apoptotic index and the contents of TNF-α,IL-10 increased, the expression of Nrf2 and HO-1 down-regulated in group PNS (allP<0.05).

Nrf2/ARE signaling pathway is involved in the reduction of ALI by penehyclidine hydrochloride in neonate rats.

The clinical data of 29 children who underwent simple ultrasound-guided tranjugular atrial septal defect (ASD) occlusion in Fuwai Hospital between January and December 2017 were retrospectively analyzed to explore the efficacy and safety of simple ultrasound-guided tranjugular ASD occlusion.

Elderly female patient with multiple admissions due to acute exacerbation of chronic heart failure. Electrocardiogram, coronary CT angiography and myocardial radionuclide imaging showed that the patient had coronary heart disease and suspected old myocardial infarction. However, this patient has few traditional risk factors for coronary heart disease, long-term low red blood cells, white blood cells and platelets, pericardial effusion, and new right atrial thrombosis. Further examination confirmed that the patient was complicated with systemic lupus erythematosus, suspected of secondary antiphospholipid antibody syndrome. Through this case, the understanding of cardiovascular damage of systemic diseases can be deepened, and the comprehensive evaluation of patients and multi-disciplinary collaborative diagnosis and treatment are very important in the diagnosis and treatment of patients.

Calcification defense is a rare syndrome characterized by calcification of the arteriole media of the skin or subcutaneous tissue, intimal proliferation, intravascular thrombosis, ischemia, necrosis and ulcer formation of the affected skin. At present, it has not been reported to occur in patients with diabetic foot. A case of diabetic refractory ulcer with calcification defense was presented. The wound was healed by local injection of sodium thiosulfate combined with autologous platelet-rich gel, hoping to attract clinical attention to this disease and help the choice of wound treatment mode.

This study reports a 53-year-old female patient who was placed with a Gelect retrievable filter due to pulmonary embolism. The filter failed to be removed by the snare method after it was broken. After that, the 14F retrieval sheath was replaced, and the filter and the broken support rod were successfully removed using a biopsy forceps.

Radiation exposure is a clear cause of thyroid cancer. However, it is still controversial whether low doses of ionizing radiation, such as radiation from X-ray exposure during diagnosis, will increase the incidence of thyroid cancer. In this paper, the research progress of diagnostic X-ray exposure and risk of thyroid cancer is reviewed.

Food allergy is a common allergic disease. Current treatment methods include avoiding diet, emergency injection of epinephrine when severe allergic reactions occur, specific immunotherapy, probiotic treatment, etc. Anti-IgE targeted therapeutic drugs can effectively reduce the concentration of IgE antibodies in serum and cell membrane surface, and improve the outcome of type I allergic reaction. Omalizumab is a recombinant humanized anti-IgE monoclonal antibody, which is particularly effective for allergic asthma and refractory chronic urticaria. In recent years, it has been gradually applied to the treatment of food allergies. The drug can be used alone for food allergy treatment or in combination with oral specific immunotherapy for food allergy treatment. The drug can reduce adverse reactions during immunotherapy, especially shock reactions; It is conducive to rapid desensitization, accelerates the progress of immunotherapy and has long-term curative effect. There are currently no valid biomarkers to evaluate the efficacy of omalizumab in the treatment of food allergies. The drug has shown great potential for treating food allergies, but the safety and efficacy remain to be confirmed by large-scale, multicenter studies.

A growing number of studies have shown that obstructive sleep apnea (OSA) is closely related to cardiovascular disease, but interventions in patients with co-existing cardiovascular disease have not shown its cardiovascular benefit. Some studies have shown that patients with OSA have cardiovascular impairment when they are not complicated with cardiovascular disease, which is manifested in all aspects of cardiovascular function. This paper briefly introduces the research progress of early damage changes of cardiovascular function in OSA patients.