Volume 99 ·  Issue 30 ·  2019

red blood cell life span (RBCS) refers to the survival time of red blood cells released from bone marrow into peripheral blood. In the physiological state, the production and destruction of red blood cells were dynamically balanced, and the average RBCS in healthy adults were 115 (70-140) days. Under pathological conditions, no matter what mechanism-mediated increase in erythrocyte destruction (i.e. hemolysis) can lead to shortening of RBCS. When erythrocyte destruction exceeds bone marrow compensatory hyperplasia, it leads to anemia. There are existing laboratory indicators that reflect increased red blood cell destruction (such as increased red blood cell fragments, decreased plasma haptoglobin, increased free hemoglobin, hemoglobinuria, hemosideruria, increased serum unconjugated bilirubin, and increased lactate dehydrogenase level) and laboratory indicators of compensatory hyperplasia of bone marrow erythroid due to hemolysis (such as increased proportion of bone marrow erythroid, increased reticulocytes, etc.), but the above indicators are affected by many factors, and their sensitivity and specificity are not high^[1,2]Early or mild atypical hemolysis cannot be determined in time and accurately. RBCS are the earliest and most direct indicators to reflect the destruction of red blood cells, so the detection of RBCS is of great value in clinical diagnosis and differential diagnosis of hemolysis.

To investigate the differences in small airway lesions in patients with different types of idiopathic interstitial pneumonia (IIPs).

A total of 46 patients with IIPs confirmed by video assisted thoracoscopic or open lung biopsy, hospitalized in the Respiratory and Critical Care Medicine of Beijing Chao-Yang Hospital, from Dec. 1998 through Nov. 2007 were studied, including 19 patients with idiopathic pulmonary fibrosis (IPF group), 14 with nonspecific interstitial pneumonia (NSIP group), and 13 cryptogenic organizing pneumonia (COP group). Pulmonary function and high resolution CT (HRCT) of the patients were examined before lung biopsy, and lung biopsy tissue were stained with hematoxylin-eosin. The abnormality of small airways in pathology, pulmonary function and HRCT were compared among these patients with IIPs.

Small airway inflammatory cell infiltration score (53.8±17.7) was significantly higher in the COP group than in the IPF group (38.8±9.7) (P<0.01). The fibrous tissue proliferation score in small airways (42.9±12.1) in the IPF group was significantly higher than that in the NSIP group (31.4±10.5) and the COP group (26.7±16.3) (both P<0.05). In the IPF group, NSIP group and COP group, the small airway function index was significantly reduced, and the maximum expiratory flow rate (V_25%, V_50%) at 25% and 50% of the lung capacity was<80% predicted, the incidences of small airway dysfunction in the three groups were 63.2%, 69.2%, and 63.6%, respectively. There was no significant difference among the groups (P>0.05). Small airway inflammatory cell infiltration was negatively correlated with V_50% of small airway function (r=-0.305, P=0.049). The bronchodilation rate in the HRCT of the IPF group (100%) was significantly higher than that of the NSIP group (50.0%) and the COP group (53.8%) (both P<0.01).

The patients with IPF, NSIP and COP have abnormal pathologic, physiological and imaging changes of small airways, moreover have different characteristics.

To analyze the clinicopathologic implications of multifocal thyroid papillary carcinoma on poor prognostic outcomes.

The clinical data of 1 681 patients suffering thyroid papillary carcinoma (PTC) was collected between June 2014 and June 2018 at the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, including 1 299 female cases and 382 male cases, with a mean age of (44.4±11.5) years, ranging from 11 to 76 years. The male-to-female ratio was 1∶3.4. The relationship between multifocality and poor prognostic indicators was further retrospectively analyzed.

Patients with multifocal papillary thyroid carcinoma were older [(46.4±11.0) years vs (43.5±11.5) years, P<0.001] and had larger tumor diameter [0.8(0.5, 0.8) cm vs 0.7(0.5, 0.7) cm, P<0.001]. The tumors were much easier to have infiltrative tumor margin, extrathyroidal extension and lymph node metastasis with multifocality (all P<0.05). The propensity score matching method was further used to match the confounding factors. Bilateral multifocal thyroid cancer was an independent risk factor for extrathyroidal extension (OR=1.983, 95%CI: 1.379-2.852, P<0.001), central lymph node metastasis (OR=2.393, 95%CI: 1.797-3.187, P<0.001) and lateral lymph node metastasis(OR=3.327, 95%CI: 2.253-4.912, P<0.001). However, unilateral multifocal thyroid cancerhad no effect on the unfavorable prognostic indicators.

Central compartment neck dissection is not recommended for unilateral multifocal thyroid cancer. However, we recommend central lymph node dissection for bilateral multifocality in PTC patients. If necessary, lateral compartment neck dissection is also supposed to be considered when lateral lymph node metastasis exists

To explore the effect of biofeedback training combined with pelvic floor muscle exercise on the recovery of anorectal function in patients with middle and low rectal cancer undergoing sphincter-preserving surgery, and to find the best way to prevent low anterior resection syndrome.

A single-center prospective randomized controlled study was conducted. One hundred and nine patients with mid-low rectal cancer in Sun Yat-sen University Cancer Centre from June 2015 to December 2016 were enrolled in the study, who were going to undergo sphincter-preserving surgery or preventive ostomy after preoperative chemoradiotherapy. They were divided into three groups: blank control group, pelvic floor muscle exercise group and biofeedback training combined with pelvic floor muscle exercise group. Intervention and follow-up were conducted for 16 months. High-resolution anorectal manometry was used to measure the objective anorectal pressure and sensory index of patients, and the Chinese version of MSKCC Intestinal Function Questionnaire was used to evaluate the intestinal function of patients. The differences of objective anorectal manometry index and subjective intestinal function between the three groups were compared, and the occurrence of low anterior rectal resection syndrome was evaluated.

At the end of the intervention, the total scores of anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time, initial rectal volume, rectal fecal sensory capacity, rectal maximum tolerance capacity, rectal compliance, anorectal hypertensive zone and total score of intestinal function in the biofeedback training combined with pelvic floor muscle exercise group were (44.83±9.01) mmHg, (4.31±1.75) mmHg, (130.46±10.00) mmHg, (19.94±4.30) s, (32.71±5.00) ml, (74.26±8.30) ml, (188.4±12.68) ml, (5.69±1.18) ml/kPa, (3.31±0.96) cm and (68.09±6.38) points respectively. The main effects of the changes of five indices, including anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time and anal high pressure zone, were time. Significant differences were found in initial rectal capacity, sensory capacity of rectal defecation, maximum tolerance capacity of rectum, rectal compliance and total score of intestinal function in every time point of measurement in the biofeedback training group combined with pelvic floor muscle exercise group. They were significantly higher than those in the blank control group (P<0.05); the score of the biofeedback training group combined with pelvic floor muscle exercise group at one month after operation, perioperative period and 3 months after operation were significantly higher than those in pelvic floor muscle exercise group (P<0.05). Biofeedback training combined with pelvic floor muscle exercise reduced the incidence of low anterior resection syndrome of rectum (P<0.05).

Biofeedback training combined with pelvic floor muscle exercise can significantly improve the sensory indicators of patients with mid-low rectal cancer, promote the recovery of intestinal function, and alleviate low anterior resection syndrome of rectal cancer patients, which is worthy of popularization and application.

To evaluate the accuracy and influencing factors of T-stage restaging of rectal cancer following neoadjuvant therapy with endorectal ultrasonography (ERUS).

In a retrospective study, endorectal ultrasound was performed in 86 patients with rectal cancer following neoadjuvant therapy. The imaging results were compared with postoperative pathological T-stage.

The accuracy of overall T-stage restaging with ERUS was 67.4% (58/86). Additionally, the accuracy of restaging in middle and high rectal cancer was higher, with an accuracy of 76.1%(35/46)and 100%(4/4) respectively. Univariate analysis showed that the location of tumors was an independent factor affecting the accuracy of ERUS(P=0.033).

ERUS is an effective method to restage T-stage of rectal cancer following neoadjuvant therapy.

This study aimed to evaluate the outcomes of colorectal obstruction patients without distant metastases treated with different strategies.

This retrospectively study included 82 patients who presented in Beijing Chaoyang Hospital from 2010 to 2015 with acute left-sided malignant colorectal obstruction. Patients with distant metastases were excluded. After informed consent, patients were divided into colonic stenting (SEMS group, n=28) , neoadjuvant chemotherapy(NCT group, n=15) or immediate emergency surgery(control group, n=39). Patients who had successful colonic stenting underwent elective surgery 1 to 2 weeks later or underwent neoadjuvant chemotherapy before elective surgery, while the other group had emergency surgery. Short-term data on postoperative mortality, morbidity, length of intensive care and hospital stay were compared. Overall survival and disease-free survival were also analyzed.

Patients in the three study arms had similar demographic profiles. The laparoscopic resection of the NCT and SEMS group was higher than that of the control group, the stoma rate was lower, and the differences were statistically significant[73.3% (11/15) , 42.9% (12/28) vs 25.6% (10/39) (P=0.006) and 13.3% (8/15) , 28.6% (8/28) vs 66.7% (26/39) (P<0.001) respectively].Compared with the SEMS and NCT group, the control group had a higher rate of postoperative complications, less of retrieved lymph nodes, longer of intensive care and lower total hospitalization expenses, and the difference was statistically significant[32.1% (9/28) , 13.3% (2/15) vs 59.0% (23/39) (P=0.004) , 21 (16,25) , 23 (19,34) vs 17 (13,25) (P=0.02) , 1.5 (0,3.0) , 1.0 (0,3.0) vs 3.0 (1.0, 4.0) (P=0.028) and 7.3 (2.8,14.1) , 11.1 (6.9,18.5) vs 7.1 (3.3,37.4) (P=0.004) respectively]. The overall and disease-free survival rate of the NCT group were higher than the SEMS group and control group, and the difference was statistically significant[93.3% (14/15) , 57.1% (16/28) vs 61.5% (24/39) (P=0.033) and 86.7% (13/15) , 53.6% (15/28) vs 51.3% (20/39) (P=0.047) respectively]. There was no significant difference among the NCT, SEMS and control group in the rate of systemic recurrence of the[6.7% (1/15) , 25.0% (7/28) vs 28.2% (11/39) (P=0.243) ].

For acute left-sided malignant colorectal obstruction without distant metastases, endoscopic stent placement combined with NCT not only is a bridge to elective operation, but also significantly improves the long-term results.

To investigate the role of actin-related protein 2-3 complex (Arp2/3) complex on phagocytosis of alveolar macrophages (AMs) in a mouse model of chronic obstructive pulmonary (COPD).

Forty mice were randomly divided into healthy control group, healthy Arp2/3 complex inhibitor (CK666) group, COPD group and COPD CK666 group with 10 mice in each group. COPD group and COPD CK666 group were established by cigarette smoke exposure, and the control group had no smoke exposure. After 90 days of molding, AMs were isolated from lung tissue of mice in each group. Mean fluorescence intensity (MFI) and the positive percent of AMs engulfing fluorescein isothiocyanate-labeled Escherchina coli (FITC-E.coli) (AM%) were detected by flow cytometry. Western blot was applied to detect protein. Laser scanning confocal microscopy was used to measure the mean optical density of Arp2, F-actin and engulfed FITC-E. coli and quantify the colocalization of Arp2 and F-actin by a Manders′ overlap coefficient. Scanning electron microscopy was used to observe the ultrastructure of AM phagocytizing FITC-E.coli.

Phagocytosis of AM: MFI and AM% in the COPD group were significantly decreased than those in the healthy control group[(4 702±243), (8 684±234) and (32.21±1.66)%, (65.88±1.77)%, all P<0.01]. MFI and AM% in the COPD CK666 group [(3 597±307), (22.09±1.89)%] and in the healthy CK666 group [(7 446±236), (50.09±1.64)%] were decreased compared to those in their respective control groups (allP<0.01). The expressions of protein of Arp2 and F-actin in the COPD group were significantly decreased than those in the healthy control group (0.508±0.025, 0.813±0.040 and 0.462±0.029, 0.720±0.039) (all P<0.01). The F-actin in the COPD CK666 group (0.265±0.014) and in the healthy CK666 group (0.637±0.032) were significantly decreased compared to those in their respective control groups (all P<0.01). The mean optical density of Arp2, F-actin and FITC-E.coli in the COPD group were significantly decreased compared to those in the healthy group (34.43±0.56, 142.83±1.90 and 61.59±0.70, 145.93±3.05 and 41.49±0.33, 189.17±2.60) (all P<0.01); the mean optical density of F-actin, FITC-E. coli in the COPD CK666 group (37.73±1.04, 28.84±2.95) and in the healthy CK666 group (137.07±1.35, 157.46±1.00) were significantly decreased compared to those in their respective control groups (all P<0.01). The Manders′ overlap coefficient of Arp2 and phalloidin′ coefficient in the COPD group (0.395±0.014) were significantly decreased than the healthy control group (0.395±0.014 and 0.880±0.002, P<0.01). The Manders′ overlap coefficient of Arp2 and phalloidin′ coefficient in the COPD CK666 group (0.297±0.006) and in the healthy CK666 group (0.737±0.031) were significantly decreased compared to those in their respective control groups (all P<0.01). Shape of AM: Long filopodia protruding and plentiful dorsal ruffle can be seen in AM from the healthy control group; AM pseudopods extension and dorsal ruffle reduced in the health CK666 group; there were pseudopods and dorsal ruffle defects in the COPD group and the COPD CK666 group. Positive correlations existed between the proteins of Arp2, F-actin with MFI. Positive correlations also existed between the Manders′ overlap coefficient of Arp2 and phalloidin′ coefficient with MFI.

Decreased activity of Arp2/3 complex leads to low phagocytosis of AM in COPD mice, and AM in COPD mice is more sensitive to Arp2/3 complex inhibitor.

To identify the therapeutic efficacy of lithium chloride (LiCl) on phosphatase and tensin homolog deleted on chromosome ten (PTEN)-deficient tumors.

First, the Catalogue of Somatic Mutations in Cancer for mutation spectrum of human endometrial carcinoma samples was analyzed. Second, the relationship between PTEN abundance and LiCl inhibition of endometrial cancer cell lines using Pten^+/+ and Pten^-/- mouse embryonic fibroblast (MEF) lines was investigated. Moreover, potential alterations of mammalian target of rapamycin (mTOR) signaling pathway after treatment with LiCl were checked.Last,LiCl′s efficacy on PTEN null tumors was studied.

PTEN was mutated in 39% of endometrial carcinomas. LiCl preferentially inhibited the proliferation of PTEN-deficient endometrial carcinoma cells and MEFs. Furthermore, LiCl blocked PTEN-deficient tumor development. Mechanistically, LiCl down-regulated mTOR signaling.

PTEN is the most frequently mutated gene in endometrial carcinoma.By targeting mTOR signaling pathway,LiCl is a promising regimen for the treatment of tumors with PTEN deficiency.

To assess the effects of clinical medicine on salt sensitive hypertension.

The PubMed, EMBASE, Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were searched to collect randomized controlled trials (RCTs) on clinical medicine in treating salt sensitive hypertension from inception to December 2018. Two reviewers independently screened the literature, extracted data, and another investigator assessed the risk of bias included in the study. Then meta-analysis was performed using RevMan 5.3 software.

A total of 16 RCTs studies involving 1 355 patients were included. Meta-analysis showed that angiotensin-converting enzyme inhibitors (ACEIs) combined with diuretics could effectively reduce 24 h systolic blood pressure variability [mean difference (MD)=4.45, 95%CI: 3.47-5.43, P<0.001] and 24 h diastolic blood pressure variability (MD=3.71, 95%CI:2.83-4.59, P<0.001) in salt-sensitive hypertension patients. Angiotensin Ⅱ receptor antagonists (ARBs) combined with diuretics had no antihypertensive effect on salt-sensitive hypertension patients. Indapamide alone can reduce systolic blood pressure (MD=-14.70, 95%CI:-18.57--10.83, P<0.001) and diastolic blood pressure (MD=-8.73, 95%CI:-11.57--5.89, P<0.001). The use of ACEIs alone in salt-sensitive hypertension patients can not reduce systolic pressure (MD=2.20, 95%CI:-1.48-5.88, P=0.240) and diastolic pressure (MD=2.95, 95%CI: 1.37~4.54, P<0.001). Amlodipine combined with metformin had therapeutic effect on salt-sensitive hypertension (RR=1.23, 95%CI: 1.14~1.33, P<0.001).

ACEIs combined with diuretics can effectively reduce blood pressure variability in salt-sensitive hypertensive patients. The use of amlodipine in combination with metformin and indapamide alone have antihypertensive effect in salt-sensitive hypertensive patients.

To appraise the clinical outcomes of barbed suture in closure of total hip and total knee arthroplasty.

Databases (Web of Science, Embase, PubMed, Cochrane Controlled Trials Register,Cochrane Library,Highwire,China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI),VIP and Wanfang database) were searched for randomized controlled trials comparing barbed sutures and conventional sutures in total hip and total knee arthroplasty published before January, 2019. Finally, 11 articles (12 randomized controlled trials) involving 1 629 hips or knees were included in this study. The meta-analysis was performed using the Review Manager software.

Compared with conventional sutures,barbed sutures resulted in shorter total wound closure time (P<0.001), less ecchymosis and needle prick (both P<0.05).There was no significant differences in terms of wound related complications, superficial infection, stitch abscess, blister, exudation, broken sutures, range of motionand KSS between barbed sutures and conventional sutures(all P>0.05).

Based on available level Ⅰ evidence, it indicated that knotless barbed suture maybe a better approach for wound closure in total hip and total knee arthroplasty.

Idiopathic pulmonary fibrosis (IPF) is one of the most common interstitial lung diseases. It is a complex heterogeneous genetic disease with complex pathogenesis and is related to mutations in many genes. Poly-A-specific ribonuclease (PARN) plays an important role in maintaining normal telomerase function, and its mutations have been associated with diseases such as pulmonary fibrosis and/or congenital dyskeratosis. This case is the first report of IPF with PARN gene mutation in China, which is the frameshift mutation caused by insertion of G base at c. 296. It is also the first report of this site in the world.

An elderly patient with endotracheal malignancy associated with hemoptysis with life-threatening tracheal obstruction and massive hemoptysis. In the treatment, CalliSpheres drug-loaded microspheres were first used to embolize the blood supply artery of the tumor, which not only reduced the risk of bleeding during endovascular resection, but also performed local chemotherapy on the tumor; Then the laser technique was used to excise the tumor in the cavity. The sequential application of the two technologies is safe and efficient.

Pancreatogenic panniculitis is clinically rare. This paper reports a case of erythema and nodules in the skin of the limbs without obvious trigger, persistent fever and admitted to hospital and finally diagnosed as "pancreatogenic panniculitis". The patient recovered after symptomatic treatment. It is hoped that this report will attract the attention of clinical medical staff and provide help for the differential diagnosis and treatment of pancreatogenic panniculitis.

The Casitas B-cell lymphoma (CBL) protein family is a group of E3 ubiquitin ligases with a RING (Really Interesting New Gene) finger domain, including three members: CBL, CBL-B and CBL-C. They play different roles in different tumors, and are closely related to the occurrence and development of tumors. A comprehensive summary of the biological functions of CBL protein family is not only helpful to understand the mechanism of related tumors, but also expected to provide new ideas and breakthroughs for CBL as a therapeutic target of tumors. Taking breast cancer as an example, the coding genes, protein structures, biological functions of CBL protein family and their role in breast cancer are reviewed.

Nocturia and enuresis are common in clinic, and their incidence is gradually increasing, which seriously affects the physical and mental health of patients. However, their definition and diagnosis are still controversial, so it is necessary to formulate uniform diagnosis and treatment criteria. This article compares the different views on nocturia and NE in domestic and foreign literatures, reviews these terms and their epidemiology and diagnosis and treatment, provides clinicians with more accurate diagnosis and treatment ideas, reduces the incidence of nocturia and alleviates the troubles caused by nocturia to patients.

In recent years, the sulfur-containing gas signal molecule hydrogen sulfide (H₂S) and sulfur dioxide (SO₂) Important progress has been made in the research of the pathogenesis of retinal-related diseases. More and more research evidence shows that sulfur-containing gas signaling molecules play an important role in the occurrence and development of many retinal diseases. Studies have found that endogenous H is present in mammalian retina₂S and SO₂Generation system. Endogenous H₂S regulates the physiology and pathophysiology of retina, and participates in the pathogenesis of retinal degenerative diseases and retinal vascular diseases. Endogenous SO₂Involved in oxidative stress-induced apoptosis of mouse retinal photoreceptor cells. Research in this field will further deepen people's understanding of the pathogenesis of retinal diseases and provide potential new targets for the intervention of such diseases.