Abstract:[abstract] Objective To explore the clinical features、diagnosis and treatment methods and prognosis of the primary tracheal Extramedullary Plasmacytoma. Methods One case of our hospital and nine cases reported in chinese-foreign language were retrospectively summarized and analyzed. Results The case in our hospital was admitted to hospital for tracheal neoplasm , patient was treated by high frequency electrocautery, and pathological findings was Extramedullary Plasmacytoma. The main symptoms of other 9 cases were dyspnea (7/9), cough (4/9) , hemoptysis (1/9). 8 cases were founded tracheal neoplasm by the means of chest CT examination, and 1 case was discovered by means of B ultrasound. 5 cases were Simplely treated by surgery; 2 cases were treated under the bronchoscope : 1 of which under rigid bronchoscope; 1 of which treated by high frequency electrocautery and high frequency electric coagulation under the bronchoscope；1 cases was treated by surgery plus local radiotherapy；1 case was treated by high frequency electrocautery 、laser and local radiotherapy. 7 cases had complete follow-up data for 3 months to 24 months, and no local recurrence and distant metastasis were founded. Conclusion Primary tracheal extramedullary plasmacytoma is a rare clinical disease, diagnosis depends on pathological and immunohistochemical results, and at present the main treatments are remove under the bronchoscope、surgical resection, or postoperative local radiotherapy.

Abstract:Objective To investigate satisfactory degree on basic medical insurance system for the aged and to provide more data for improving insurance policies. Methods A face-to-face questionnaire survey was carried out with 367 elderly residents in Zhoupu communities in Shanghai using cluster random sampling method. The survey included social demographic characteristics, medical insurance, chronic disease, health cost, etc. The data were analyzed using descriptive statistical analysis, Chi-square test and multivariate logistic regression analysis by SPSS software. Results Totally 357 effective questionnaires were collected, with the effective rate being 97.3%. The overall satisfaction rate of the retired employees was high according to our survey, but the satisfaction rates of urban non-employed residents and land-requisitioned peasants were relatively low (P<0.001). Single factor analysis and multiple factor analysis both revealed that income, number of chronic diseases and self-rating health had significant association with satisfaction rate of the participants (P<0.05). Conclusion The basic medical insurance for urban non-employed residents and landless peasants needs to be further improved.

Abstract:Objective To explore the correlation of propaganda methods of pre-exposure prophylactic medication with sociodemographic characteristics and obtaining services of HIV prevention in men who have sex with men (MSM) in Western China by applying multiple correspondence analysis. Methods A cross-sectional survey was carried out on 1 407 MSM who were selected from Chongqing, Sichuan, Guangxi province by snowball sampling method. Chi-square tests and multiple correspondence analysis were used for selecting variables and exploring correlation. Results Totally 1 323 qualified participants were recruited and only 31.49%(416/1 321) had ever heard of pre-exposure prophylactic medication. It was found that 74.00%(979/1 323), 65.00%(860/1 323), 44.22%(585/1 323) and 52.15%(690/1 323) of MSM were willing to obtain pre-exposure prophylactic medication knowledge via internet, traditional media, peer education and medical institutions, respectively. In multiple correspondence analysis the Cronbach α values were 0.661 and 0.632 while eigenvalues were 2.562 and 2.400 in two dimensions of all variables. Willing to obtain pre-exposure prophylactic medication knowledge via internet was strongly correlated with higher education, unmarried status, younger than 30 years old, no children and urban residency. Willing to obtain knowledge by peer education was strongly correlated with having ever received information from peers, having received promotional materials, having received free AIDS consultation and participated in activities of MSM. Conclusion Multiple correspondence analysis can directly reveal the correlation among propaganda methods of pre-exposure prophylactic medication, sociodemographic characteristics and services of HIV prevention, which provides a theoretical basis for propaganda and research of pre-exposure prophylactic medication among MSM in China.

Abstract:Objective To evaluate the intraocular pressure (IOP)-lowering effects achieved by nonpenetrating glaucoma surgery (NPGS) in patients with open angle glaucoma. Methods Randomized controlled trials evaluating patients with primary and secondary open angle glaucoma treated with NPGS were identified and were subjected to systematic review analysis. The main outcome measurements included the percentage of IOP reduction and the complete success rate. The pooled estimates were calculated using the random effect model by comprehensive meta-analysis software version 2.0. Results Both deep sclerectomy (DS) and viscocanalostomy (VCO) were less effective than trabeculectomy (TE) in lowering IOP, with the of IOP reduction percent at 2 years being 35.2% for DS, 30.2% for VCO, and 45.6% for TE. Intraoperative use of implants and mitomycin C (MMC) improved IOP-lowering effects of DS, with IOP reduction at percent 2 years being 41.1% and 41.7%, respectively. The complete success rates at 4 years were 35.4% for DS and 22.7% for VCO, lower than that of TE (47.6%). The complete success rates of DS with implants and MMC were 64.6% and 52.1% at 4 years, respectively, both being higher than that of primary DS. NPGS caused less complications than TE. Conclusion Primary deep sclerectomy and primary viscocanalostomy can significantly lower IOP and have less complication than TE. However, the IOP-lowering effect of NPGS is slighter than primary TE. The efficacy of DS can be improved by intraoperative use of implants and MMC.

Abstract:Objective To identify the risk factors of acute renal failure following operation in patients with acute type A aortic dissection(AAAD).Methods The clinical data of 266consecutive patients undergoing operation for AAAD between Jan.2002and Mar.2013were retrospectively analyzed.The patients were divided into two groups according to the presence of postoperative acute renal failure.The general data were compared between the two groups.Univariate and multivariate conditional logistic regression analysis were used to determine the independent risk factors of postoperative acute renal failure. Results Eighteen (6.77%)patients had acute renal failure in our study.The incidence rates of preoperative cardiac dysfunction(NYHA Ⅲ-Ⅳ)(P=0.024),renal insufficiency(P=0.002),cardiopulmonary bypass time(CPBT)≥190min (P=0.000),aortic cross-clamp time≥90min(P=0.015),postoperative re-operation for bleeding(P=0.004),brain damage(P=0.013),acute respiratory dysfunction(P=0.000)and perioperative erythrocyte transfusions(P=0.015)were significantly different between the two groups preoperatively.Multivariate conditional logistic regression analysis showed that preoperative renal insufficiency(OR=6.978,95%CI:1.874-25.997),CPBT≥190min(OR=5.663,95%CI:1.621-19. 781),perioperative erythrocyte transfusions (OR=1.071,95% CI:1.030-1.113)and postoperative acute respiratory dysfunction(OR=4.853,95% CI:1.467-16.053)were independent risk factors for postoperative acute renal failure. Conclusion Renal failure is a severe complication caused by many risk factors after operation in AAAD patients.The patients should be monitored closely early after operation;the risks of acute renal failure should be assessed and individualized intervention should be given to improve hospital mortality and prognosis.

Abstract:Objective To establish a dual contrast-enhanced ultrasonography (DCEUS) method for diagnosing the upper urinary tract obstructive diseases, and to discuss the diagnosis criterion and value. Methods A total of 147 patients with upper urinary tract obstructive diseases underwent dual contrast-enhanced ultrasound examination. A dose of SonoVue solution was directly injected into the renal pelvis via the puncture tube, and the antegrade contrast agent movement within the upper urinary tract was continuously monitored under CPS mode. Meanwhile, intravenous contrast-enhanced ultrasound was performed to observe the capillary filling of the urinary tract and surrounding structures, that is what we called DCEUS. And all the patient received magnetic resonance urography (MRU) and urinary contrast-enhanced CT within one week. With the operative findings and/or postoperative pathology taken as the golden standard, the accuracies of DCEUS and MRU in diagnosing the obstructive levels and severity of upper urinary tract obstruction were compared, and the accuracies of DCEUS and contrast-enhanced CT in diagnosing causes of the obstruction were compared. Results (1)The accuracy of DCEUS in revealing the obstructive levels were 100%, showing no significant difference with MRU(98.6%)(P>0.05). (2)The accuracy of DCEUS in evaluating the severity of upper urinary tract obstruction was 98.6%, which was significantly better than that of MRU(89.8%, P<0.01). (3) The accuracy of DCEUS in diagnosing the obstructive causes was 93.2%, showing no significant difference with contrast-enhanced CT (93.9%, P>0.05). (4) No complications were found during renal pelvis puncture or administration of SonoVue in the 147 patients,and no late complications were noticed during 1-6 months ultrasound follow-up in the 143 patients who were followed up. Conclusion DCEUS is a safe, effective method; it can accurately locate the upper urinary tract obstruction and help to make qualitative diagnosis, and combination with percutaneous nephrostomy can yield even better clinical values.

Abstract:Objective To explore a new method for repairing bilateral acute proper digital nerve injuries. Methods From Feb. 2009 to Aug. 2012, 56 patients with bilateral acute proper digital nerve injuries were admitted to our center, with 20 undergoing double end-to-side neuroanastomosis. During operation, the injured digital nerve was excised, and then the bilateral distal ends and proximal ends were stured, consequently forming the distal and proximal nerve bows. A cutaneous antebrachⅡ lateralis nerve was freed and obtained from the homolateral forearm, and then was equally divided into 2 parts to bridge the 2 nerve bows. Twenty patients underwent nerve graft with end-to-end neuroanastomosis, and the rest 16 patients underwent direct end-to-end neuroanastomosis. Results All the patients achieved primary healing of wound after operation, with no circulation disorders. A total of 50 patients were followed up for 3-12 months. In double end-to-side neuroanastomosis group, 18 patients were successfully followed up, with the average sensation measurement being S3⁺, which was significantly higher than those of the other 2 groups(P=0.024). The average result of two point discrimination was (5.2±0.7) mm, which was significantly lower than those of the other 2 groups(P=0.037). According to TAM scales, the results of finger joint motion were excellent in 14 cases, good in 3 cases and fair in 1; and there were no significant differences in the motion of joints between the 3 groups (P=0.914). In nerve graft with end-to-end neuroanastomosis group, 19 patients were successfully followed up; the average result of sensation measurement was S2 and the average result of two point discrimination was (7.2±1.4) mm. In direct end-to-end neuroanastomosis group, 13 patients were successfully followed up; the average result of sensation measurement was S3 and the average result of two point discrimination was (6.3±0.8) mm. Conclusion The arched nerves of double end-to-side neuroanastomosis can be used for repairing bilateral acute proper digital nerve injuries, which can quickly restore the sensation of fingers, but the related conclusion needs further verification with large sample studies.

Abstract:Objective To investigate the serum level of angiotensin Ⅱ type 1 receptor (AT₁R) agonistic autoantibody (AT₁-AA) in hyperthyroidism rats with cardiac hypertrophy and the expression of PI3K and protein kinase B (Akt) in cardiac tissue, so as to study the relationship between AT₁-AA and PI3K/Akt signaling pathway. Methods Hyperthyroidism rats models were established by gavaging with levothyroxine sodium. Totally 54 SD rats were divided into three groups: hyperthyroidism group(group A), hyperthyroidism+olmesartan group(group B) and control group (group C). The heart weight index (HWI) and atrial natriuretic peptide (ANP) mRNA were taken as the indices for cardiac hypertrophy. Serum AT₁-AA level was determined by enzyme-linked immunosorbent assay (ELISA), and the expression of AT₁R and PI3K/Akt was detected by Western blotting analysis. According to the determination results of AT₁-AA, group A and B rats were subdivided into AT₁-AA positive group and negative group; the expressions of AT₁R and PI3K/Akt were compared between these groups. Results (1) Compared with group C, HWI and the expression of ANP mRNA in group A and B were significantly increased (all P<0.05); and those in group A were significantly higher than those in group B (P<0.05). (2) The positive rates and OD values of AT₁-AA in group A and B (61.11%, 72.22% and 0.44±0.12, 0.49±0.08) were significantly higher than those in group C (16.67% and 0.28±0.05) (all P<0.01).(3)The expressions of AT₁R and PI3K/p-Akt in group A and B were significantly higher than those in group C (P<0.05, P<0.01). Compared with group A, the expression levels of PI3K, p-Akt were significantly decreased in group B (P<0.01, P<0.05). (4) In group A, the expression levels of PI3K and p-Akt in AT₁-AA positive group were significantly higher than those in AT₁-AA negative group(P<0.01); in group B, the expression levels of PI3K and p-Akt in AT₁-AA positive group were significantly decreased than those in AT₁-AA negative group (P<0.05). Conclusion AT₁-AA may be involved in the pathophysiology of cardiac hypertrophy in hyperthyroidism by activating PI3K/Akt signaling pathway through AT₁R.

Abstract:Objective To investigate the water soluble chemical constituents in the root of Valeriana officinalis Linn. var. latiofolia Miq. and to identify their structures. Methods The water soluble chemical constituents were isolated and purified by macroporous resin Diaion HP-20, silica gel and Sephadex LH-20; the chemical structures of the components were determined by MS, 1D NMR and 2D NMR spectral analysis. Results and conclusion Thirteen constituents were isolated and identified from the root of Valeriana officinalis Linn. var. latiofolia, including Ganxinoside A (1), (-)-angelicoidenol-2-O-β-D-glucopyranoside (2), (-)-angelicoidenol-2-O-β-D-apiofuranosyl-(1→6)-β-D-glucopyranoside (3), 6-hydroxy-7-(hydroxymethyl)-4-methylenehexahydrocyclopenta[c]pyran-1 (3H)-one (4), kanokoside A (5), prinsepiol-4-O-β-D-glucopyranoside (6), (+)-pinoresinol-4-O-β-D-glucopyranoside (7), sinenoside Ⅰ (8), lanicepsides A (9), (+)-1-hydroxypinoresinol-1-O-β-D-glucoside (10), (+)-pinoresinol-4, 4'-O-bisglucopyranoside (11), (+)-cycloolivil 6-O-β-D-glucopyranoside (12), and coniferin (13). All the 13 compounds are isolated from the root of Valeriana officinalis Linn. var. latiofolia Miq. for the first time.

Abstract:Objective To synthesize PEG-P[Asp(DET)] with 10% cholesterol chloroformate modified on its side chain and to study the physicochemical properties and cellular uptake of polymer complex PEG-P[Asp(DET)]-chole/hsa-miR-15a. Methods PEG-P[Asp(DET)] was synthesized by ring opening polymerization and modification with cholesterol chloroformate to acquire hydrophobicity, and MRI was used to verify its structure. The particle size, Zeta potential, stability, encapsulation efficiency, and cytotoxicity of the polymer complex PEG-P[Asp(DET)]-10% chole/hsa-miR-15a were examined. Finally, in vitro cellular uptake experiment was carried out with the leukemia cell line K562. Results The synthesized polymer PEG-P[Asp(DET)]-10% chole had fine solubility and could form into stable polymer complex PEG-P[Asp(DET)]-chole/hsa-miR-15a. When nitrogen-phosphorus ratio (N/P) was at 20 and concentration of the miRNA was 5 μmol/mL, the particle size was (192.4±10.8) nm, Zeta potencial was (6.9±0.9) mV, and encapsulation efficiency was (90.5±3.2)%. The complex displayed good stability under experimental condition. In vitro cellular uptake experimental indicated that the uptake capacity of PEG-P[Asp(DET)]-10%chole/hsa-miR-15a was higher than that of the commercial agent lipo2000. Conclusion PEG-P[Asp(DET)]-10%chole is a fine gene polymer carrier for miRNA and can achieve stable cellular uptake of miRNA.

Abstract:Objective To study the essential oil components in herbal pair (HP) of Radix Angelica dahurica-Ligusticum chuanxiong Hort.(RAD-LCH) and its single herb, and to investigate the influence of HP on the components of the volatile oil. Methods Essential oil was extracted from Radix Angelica dahurica and Ligusticum chuanxiong Hort. by steam distillation. Identification of extracted components was accomplished using GC-MS technique combined with library searching and literature comparison. Chromatography analysis was carried out on a TR5-MS capillary column (30 m× 0.25 mm, 0.25 μm); the carrier gas was high-purity helium; the inlet temperature was 250℃; the injection volume was 1 μL, the split ratio 501; constant current mode, the flow rate of carrier gas was 1.00 mL/min; the temperature program was as follows: 50℃ for one minute, rose to 240℃ at 5℃/min and maintained for one minute, then rose to 280℃ at 5℃/min and maintained for one minute. MS condition was as follows: electron impact (EI) ion source, electron energy 70 eV, ion source temperature 200℃, transmission line temperature 280℃, mass scan range m/z:50-650 amu, data acquisition scan mode for full scan, and solvent delay five minutes. Results There were 69, 59, 59, 60 and 78 volatile constituents in RAD, LCH, HP (1:1), HP (4:1) and essential oil of mixture of equal concentration from RAD and LCH (EOEC), and 19 common volatile components were identified. Conclusion Regarding the volatile oil constituents and content, the volatile oil compositions of different HP proportions vary greatly, accompanied by changed contents of volatile oil components of single herb in HP.

Abstract:Objective To construct a knock-in targeting vector for expressing of Cre recombinase specifically in islet β cell and provide the key material for knock-in mice with Cre recombinase expressed in islet β cells, providing a knock-out animal model for studying the function of islet β cells. Methods In our study, we constructed a knock-in targeting vector using the third exon of insulin 2 (Ins2) as a target site with λ phage Red recombination system. Through a first homologous recombination, we cloned an about 12 kb genomic DNA fragment from the bacterial artificial chromosome (BAC) which contained Ins2 genomic DNA into a low copy vector pBR322-2s through gap repair. Meantime, a mini-targeting vector containing internal ribosome entry site (IRES), DNA sequences encoding Cre recombinase and positive-negative-selection (PNS) gene was generated. After second recombination, the final Ins2-Cre targeting vector was generated. Results With the third exon of Ins2 used as the target, we successfully constructed the knock-in targeting vector expressing Cre recombinase which was controlled by endogenous Ins2 gene. Conclusion We have successfully constructed the knock-in targeting vector expressing Cre recombinase, it will provide an important material for creating animal model of Cre recombinase which is specially expressed in islet β cells.

Abstract:Objective To study the effects of ablation site in catheter-based renal sympathetic denervation (RDN) on antihypertensive results in patients with resistant hypertension. Methods A total of 16 patients with resistant hypertension were evenly randomized into two groups: proximal or distal ablation group. RDN was performed after examination. The ablation parameters, including impedance starting value, minimum impedance, actual wattage, and the actual temperature, were recorded intraoperatively. Renal angiography was done again immediately after RDN. Standardized BP measurements were obtained in all patients for 3 months after operation. Results All the 16 patients underwent RDN successfully. The average initial impedance of the 16 patients was (180.0±12.3) Ω, average minimum impedance was (157.8±12.8) Ω, and average impedance drop rate was (12.4±2.6)%. The actual ablation temperature was 40-50℃, with the actural ablation wattage being 5-18 W. The renal angiography showed two cases of renal artery spasm in the distal ablation group and none in the proximal group, with no significant difference found in the incidence between the two groups (P=0.08). There was no significant difference in BP between the two groups 3 months after RDN. Conclusion Proximal ablation, particularly at the opening of renal artery, may not influence the antihypertensive effect of RDN, and to some extent it can reduce the incidence of renal artery stricture.

Abstract:Generally, human adipocytes can be broadly divided into white and brown fat cells. White fat cells are specialized to store chemical energy and brown adipocytes can produce heat under external stimulation. Recent studies have demonstrated that when mice are exposed to cold or receive β-adrenergic stimulation, some brown-fat-like cells may appear in the subcutaneous white adipose depot, and these cells are called "beige cells". Beige cells have the characteristics of both white and brown fat cells and can transfer to each other. Biologically brown fat in adult humans is similar to beige cells. This paper is to review the research progress on beige cells.

Abstract:Osteogenesis imperfecta is a group of systemic connective tissue diseases characterized by increase in bone fragility and collagen metabolic disorder. The condition is mainly caused by mutations in the genes encoding type Ⅰ collagen. The clinical features of the diseases include bone fragility, progressive bone and joint deformity, blue sclera, dentinogenesis imperfecta and hearing loss. Currently, the most promising drug for treatment of the disease is bisphosphonate. This article reviews the following issues: optimal dose and duration of treatment, best route for administration, best drug choice, and the optimal match of drugs with the osteogenesis imperfecta type and age of patients.

Abstract:Diterpenoids are the characteristic secondary metabolites of the soft corals of the genus Sarcophyton. The intriguing structure and broad spectrum of bioactivity of these metabolites have drawn great attention from the chemistry and pharmacology fields, and they have become a focus of study in marine natural products. In 1997 Indian researchers reviewed the related studies of the soft corals of the genus Sarcophyton. This paper summarizes the research progress in 12 identified and 13 unidentified species of this genus reported in 54 citations published from 1998 to the Oct. of 2013, involving 143 compounds.

Abstract:Objective To assess the efficacy and safety of posterior reduction and short pedicle screw fixation at fracture level (method A) for treatment of single level compress thoracolumbar fractures. Methods The clinical data of 87 patients with single level compress thoracolumbar fractures, who were surgically treated between January 2010 and January 2012 in our hospital, were retrospectively analyzed. treated by posterior. The patients were divided into two groups according to surgical methods. Group A: Patients were treated with method A; Group B: Patients were treated by conventional posterior decompression, redultion of fracture and short segment fusion and internal fixation. The operation time and intraoperative blood loss were recorded and the postoperative pain was evaluated. The adjacent vertebral Cobb angle and the anterior height of the injured vertebra on the lateral radiographs were measured before surgery, immediately after surgery, and 1 year after surgery, and the vertebral compression ratio was calculated. Results Among the 73 patients who were finally included in the study, 38 were in group A and 35 in group B. There were no significant differences in patient age, compression ratio, Cobb angle before or after surgery between the two groups. The operation time in group A was signficantly longer than that in group B(121 min vs 92 min,P<0.05); the compression ratios immediately and 1 year after surgery in group A were significantly higher than those in group B ([immediately after surgery: 91.3% (82%-93%) vs 77.2% (73%-86%), P<0.05; 1 year after sugtery: 87.2% (79%-93%) vs 73.1%(68%-80%),P<0.05]). The Cobb angle at 1 year after operation in group A was significantly smaller than that in group B (7.8°[0°-15°] vs 11°[2°-17°],P<0.05). There was no significant differences in blood loss or scores of low back pain between the two groups. Conclusion Posterior reduction and short pedicle screw fixation can safely and effectively reconstruct the vertebral body height and correct kyphosis in patients with single level compress thoracolumbar fractures.

Abstract:Objective To observe the popliteal artery anatomy courses at different levels of knee using computed tomography angiography (CTA) scan, so as to explore the best CTA monitoring level in lower limb popliteal artery. Methods A retrospective analysis of popliteal artery images was conducted in 47 (94 sides) diabetic patients from May 2012 to April 2013. The image data were divided into three groups, namely, the upper edge (group A), the middle portion (group B) and the lower edge (group C) of the patella. The relation between popliteal artery and popliteal vein was analyzed and the occurrence of popliteal artery plaques was evaluated. Results In group A, 76 sides of popliteal artery were observed in the anteromedian of the popliteal vein, 11 sides in the front, 1 side in the anterolateral, 1 side in the lateral of the popliteal vein, and 5 sides were unclear due to disturbance by other vessels. In group B, 68 sides of popliteal artery were recorded in the anteromedian of the popliteal vein, 10 sides in the front, 3 sides in the anterolateral, 1 side in the posterior of the popliteal vein, and 12 sides were unclear due to disturbance by other vessels. In group C, 41 sides of popliteal artery were found in the anteromedian of the popliteal vein, 17 sides in the front, 4 sides in the anterolateral, 1 side in the lateral, 2 sides in the posterior of the popliteal vein, and 29 sides were unclear due to disturbance by other vessels. Results of χ² test indicated that the stability of the popliteal artery in group A and B was significantly higher (P<0.05) and the vascular disturbance was significantly less (P<0.05) than those in group C. The incidence of plaque in group A (44.68%, 42/94) was significantly higher than that in group B (25.53%, 24/94, P<0.05). Conclusion The median patella level is the best CTA monitoring level for lower limb popliteal artery. When the popliteal artery at the median patella level is hard to identify, the upper edge level of the patella can be chosen as an alternative.

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