[The clinical and laboratory characteristics of congenital pyruvate kinase deficiency]

Clinical data of 19 patients with congenital pyruvate kinase deficiency were analyzed. Insufficient pyruvate kinase confirmed the diagnosis. Laboratory parameters of hemolysis were summarized. In cases of neonatal hyperbilirubinemia and unexplained hemolytic anemia, pyruvate kinase activity and next generation sequencing test may help the early diagnosis.

[Experience and reflection of diagnosis and treatment in insulinomas]

The insulinoma, which is the most common pancreatic neuroendocrine tumor, can be misdiagnosed and mistreated easily.Recently, the misdiagnosis rate has decreased significantly owing to the establishment of diagnosis and treatment system.However, the misconception about its diagnosis and treatment still exists because the diagnosis and treatment level varies greatly among different centers.This article aims to summarize the experience in the diagnosis and treatment of insulinoma in Peking Union Medical College Hospital, and introduce the qualitative and localization diagnosis, surgical and interventional treatment and perioperative management about insulinoma, so as to standardize the diagnosis and treatment procedure in China.

[Investigation and analysis of the activities of daily living of the aged at home in western China]

OBJECTIVE

To investigate the current situation of the activities of daily living (ADL) of the aged at home in western China, and to analyze its influencing factors so that we can improve the quality of life and pension services of elderly people.

METHODS

The elderly people who came from Qinghai Province, Ningxia Autonomous Region, Xinjiang Uygur Autonomous Region, Shanxi Province, Guizhou Province, Guangxi Province, Sichuan Province, Yunnan Province and Chongqing were surveyed by questionnaires. Logistic regression model was used to analyze the influencing factors of ADL.

RESULTS

A total of 7 175 aged people living in the western China were surveyed. In the study, 78.86% of the aged at home could independently live. 12.32% of the aged were of mild dysfunction. 6.27% of the aged had moderate dysfunction. And 2.55% of the aged suffered severe dysfunction. Multiple Logistic analyses indicated that age, educational level, economic income, body mass index and disease were the factors that affected their ADL. The risk of decreased ADL in the 60-69 and 70-79year-old groups were 0.221 (95%CI: 0.190-0.258) and 0.353 (95%CI: 0.305-0.409) times that of the elderly over the age of 80. Compared with illiterate seniors,the risks of decline in ADL of primary school, junior high school, secondary or high school, college or undergraduates, postgraduates or above were 0.299 (95%CI: 0.140-0.637), 0.312 (95%CI: 0.146-0.663), 0.238 (95%CI: 0.112-0.510), 0.226 (95%CI: 0.105-0.484), and 0.238 (95%CI: 0.110-0.514) times. The declines in the risk of ADL for elderly people with quite difficult economic conditions, slight difficulty and breaking even were 2.720 (95%CI: 2.015-3.672), 2.344 (95%CI: 1.816-3.027), and 1.542 (95%CI: 1.215-1.957) times of the economically abundant people. Compared with those with a body mass index (BMI)≥28, the risk of ADL reduction for BMI<18.5 was 1.577 (95%CI: 1.142-2.179) times. And the ADL of the elderly with no disease was at the risk of falling 0.685 (95%CI: 0.602-0.779) times that of an elderly person with the disease.

CONCLUSION

The activities of daily living of age at home of western China are not high, and affected by many factors, such as age, educational level and so on. With the increasing of the elderly, maintaining and improving the ADL are the problems and challenges that we are faced with.

[The expression of KLK7 in pancreatic cancer and the effects on the biological behavior of pancreatic cancer cells]

Objective: To investigate the expression of KLK7 in pancreatic cancer and its clinical significance. Methods: Immunohistochemistry was used to detect the expression of KLK7 protein in pancreatic cancer tissue microarray with 92 samples. Statistical analysis of the relationship between KLK7 and clinicopathological characteristics was finished. Pancreatic cancer cell lines were infected with lentiviuses in order to get cells with KLK7 stable overexpression.KLK7-siRNA was transfected into pancreatic cancer cells to knock down KLK7.Cell proliferation and chemosensitivity were detected by CCK-8 assay; Cell invasion and migration abilities were detected by Transwell assay. At the same time, subcutaneous xenograft tumor models were established in nude mice to observe the effect of KLK7 on tumor growth in nude mice. Data were statistically analyzed by rank sum test, χ(2) test and Logistic regression analysis. Results: The expression level of KLK7 in pancreatic cancer tissues was higher than that in paired adjacent tissues (P<0.05). KLK7 expression was correlated with vascular invasion(χ(2)=7.535, P<0.05). Further univariate and multivariate analysis showed that KLK7 expression was an independent risk factor for vascular invasion of pancreatic cancer(χ(2)=7.535, P<0.05). The overexpression of KLK7 in pancreatic cancer cell lines BxPC-3 and CFPAC can increase their proliferation abilities, reduce the chemosensitivity and promote their migration and invasion behaviour; The results of in vivo experiments showed that the volume of subcutaneously transplanted tumors in the overexpressing KLK7 group was significantly larger than that in the control group (t=4.479, P<0.05). The group of overexpressing KLK7 showed greater tumor weight than the control group(t=2.831, P<0.05). Conclusions: The expression level of KLK7 in pancreatic ductal adenocarcinoma was higher than that in paired adjacent tissues and it is an independent risk factor for vascular invasion of pancreatic cancer.KLK7 can promote the proliferation of pancreatic cancer cells, reduce the chemosensitivity and increase the invasion and migration of pancreatic cancer cells.

Accumulation of High Levels of Monocytic Myeloid-Derived Suppressor Cells Enhances Graft Survival in Almost-Tolerant Kidney Transplant Recipients

BACKGROUND

Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature cells that suppress immune responses during organ transplantation and participate in mediating long-term graft survival and immune tolerance in animal transplant models. However, their role in regulating transplant tolerance in human subjects is not well understood. In the present study, we investigated the role of MDSCs in mediating long-term graft survival in almost-tolerant kidney transplant recipients (ATKTRs) and the mechanism(s) responsible for increasing MDSC numbers in these recipients.

METHODS

Peripheral blood mononuclear cells (PBMCs) from whole blood samples were collected from 30 ATKTRs (graft survival, > 10 years after kidney transplant [KTx]) treated with low doses of immunosuppressive drugs and with stable kidney function, 10 short-term graft survival kidney transplant recipients (STKTRs; graft survival, ∼1-3 years post-KTx) with stable kidney function, and 10 healthy donors (HDs). MDSC and regulatory T cell (Tregs) levels were analyzed using multicolor flow cytometry in PBMCs.

RESULTS

ATKTRs had significantly higher levels of monocytic MDSCs (P < .001) and CD4⁺CD25⁺FoxP3⁺ Tregs than STKTRs and HDs. Furthermore, the M-MDSC levels correlated positively with the survival rates, estimated glomerular filtration rates (eGFRs) of grafts, and the levels of CD4⁺CD25⁺FoxP3⁺ Tregs in ATKTRs.

CONCLUSIONS

Accumulation of high levels of MDSCs was observed in ATKTRs. Changes in MDSC levels may play important roles in mediating transplant tolerance and regulating Tregs. Therefore, we propose that MDSCs may be potentially used for recognizing tolerant transplant recipients and guiding dosage reduction for immunosuppressive drugs for KTx.

[The progress of Chinese surgery in 2017]

The article outlined the speeches of Surgeon Branch during the Annual Scientific Conference of Chinese Medical Association in 2018.From the perspectives of inheritance, innovation, standardization and improvement, it summarizes the major progress of Chinese surgery in 2017 and introduces the objectives and action plans of Chinese Medical Association Branch of Surgery this year.

[Opportunities and challenges in the development of pancreatic surgery]

Pancreatic surgery is characteristic of various and complicated diseases and difficult surgeries. Pancreatic surgeons are required to grasp the new concept, apply new techniques and comprehend the study trends of pancreatic diseases. Otherwise, pancreatic surgeons should fully realize the opportunities and challenges resulted from application of new concept and techniques as well as learning new concept and techniques. Meanwhile, they should grasp the updating guidelines and research progress, intensively promote the development of prospective multicenter research involved in multidisciplinary team, and then promote the rapid development of pancreas surgery in China.

[Bit1 mediates the malignant behaviors in pancreatic cancer and its potential clinical significance]

Objective: To investigate the potential role of Bit1 in the pathogenesis of pancreatic ductal cancer cells(PDAC) and its potential clinical application value. Methods: Real-time PCR and Western blot were employed to detect the expression of Bit1 in six pancreatic cancer cells, then the tool cells were selected to further study the function of Bit1.PolyHEMA was used to monitor the suspended cell culture condition in vitro.The invasion and migration abilities of pancreatic cancer cells were detected through Transwell assay. Western blot and confocal assay were used to explore the potential mechanism of Bit1 in the process of metastasis.The expression of Bit1 was detected through tissue microarray, the potential relationship between Bit1 and other clinical factors were analyzed. Results: The results of real-time PCR and Western blot indicated that the expression of Bit1 was highest in the PANC1 cells and lowest in the Mia paca2 cells (gene: 3.13±0.40 vs. 1.00±0.35, protein: 1.77±1.00 vs. 0.23±0.45). The shBit1 PANC1 and Bit1-OE(over expression) Mia paca2 cells were successfully constructed.Bit1 over expression could promote the anoikis rate of Mia paca2 cells, and Bit knockdown could inhibit the anoikis incidence.Bit1 over expression suppressed the motility and invasion of Mia paca2 cells, but Bit1 knockdown could accelerate the migration and invasion ability of PANC1 cells.Bit1 could potentially affect pancreatic cancer cells' malignant behaviors through epithelial-mesenchymal transition process.Bit1 expression was significantly associated with pancreatic cancer's neural invasion (P<0.05). Conclusions: Bit1 could affect the anoikis incidence of pancreatic cancer, Bit1 negatively affect the migration and invasion abilities of PDAC, the EMT process was potentially involved in the whole modulation process.Bit1 expression is associated with neural invasion in pancreatic cancer patients.

[Expression and localization of transmembrane protein CMTM2 in human testis and sperm]

OBJECTIVE

To study the expression of transmembrane protein CMTM2 in the testis and sperm of adult males and to approach the potential function of the protein in the male reproductive system.

METHODS

The expression of CMTM2 in human testis and sperm was confirmed by Western blot. Immunohistochemical staining was used for detecting CMTM2 localization in the testis tissue, TRITC-CMTM2 and FITC-Hoechst double immunofluorescence staining was performed to examine the subcellular localization of CMTM2 in the human sperm before and after acrosome reaction, that is, immunofluorescent staining was used for detecting CMTM2 localization in both the testis and sperm before and after the acrosome reaction.

RESULTS

CMTM2 was presented in both human testis and sperm. In the testis, CMTM2 immunoreactive particles were observed mainly in the membrane of the different stages of spermatogenic cells. In the human sperm, its immunoreactivity was restrictively localized to the posterior head where sperm-egg fusion occurred, and the CMTM2 localization was not affected by sperm acrosome reaction. CMTM2 was widely expressed in seminiferous tubules of the human testis, mainly in the cell membranes of spermatogenic cells, which was consistent with the previous reports. The immunofluorescence performed on frozen human testis slides showed similar findings with immunohistochemistry, which gave weight to the localization of CMTM2 in the cell membranes of spermatogenic cells at different stages. TRITC-CMTM2 and FITC-Hoechst double immunofluorescence staining was performed to examine the subcellular localization of CMTM2 in the human sperm before and after acrosome reaction. CMTM2 was localized at the posterior head of sperm before and after acrosome reaction. The localization and expression of CMTM2 were not affected by sperm acrosome reaction.

CONCLUSION

Expression of CMTM2 in the male reproductive system of the adult human exhibits cell- and region-specific patterns, which suggests that they may play an important role in spermatogenesis and sperm-egg fusion. The expression of CMTM2 in the male reproductive system of the adult human exhibits cell- and region-specific patterns, which suggests that they may play an important role in spermatogenesis and sperm-egg fusion. However, it still remains to be further elucidated about the definite role of CMTM2 in male reproductive system and the process of spermatogenesis. And in vitro fertilization experiments are needed to confirm the role of CMTM2 in fertilization in future.

[The application of short stent in root of aorta for the treatment of Stanford type A aortic dissection]

Objective: To explore the effect of implanting short stent in root of aorta for the treatment of Stanford type A aortic dissection. Methods: Clinical data of 39 patients with Stanford type A aortic dissection who underwent surgical procedure at the Department of Cardiovascular Surgery of Luoyang Central Hospital Affiliated to Zhengzhou University, between January 2013 and December 2015 were retrospectively analyzed. There were 31 males and 8 females aged 27 to 75 (49.3±10.3) years. All patients received short stent implanting in aortic root, total arch replacement and stented elephant trunk implantation were performed at the same time. Results: All the operations were successfully performed. Two patients died during hospitalization. Four patients underwent reexploration for postoperative bleeding. Postoperative mortality was 5.1%(2/39). Follow-up duration was 3 to 24 months, with a median time of 14 months. One patient died of lung infection, gastrointestinal bleeding and renal faliure during follow-up. Conclusion: Patients with aortic intimal tear located at higher root of aorta may be suitable for short stent implanting, and the procedure has satisfactory clinical outcomes.

[Correlation between miR-1178 expression and clinicopathological significance in human pancreatic cancer]

Objective: To test the expression of miR-1178 in pancreatic cancer and study its clinicopathological significance and mechanism. Methods: The expression of miR-1178 in 87 paired paraffin pancreatic ductal adenocarcinoma specimens and adjacent non- cancerous pancreatic tissue diagnosed by Pathology Department of Peking Union Medical College Hospital was detected by hybridization in situ. The relationship between the expression of miR-1178 and clinicopathological characters was analyzed.miR-1178 mimics and inhibitor were used to further detect the close relationship among miR-1178 and cancer invasion. Establish a nude mice subcutaneously transplanted tumor model, 4 weeks after vaccination for tumor volume and weight measurement.Student t-test, rank sum test, and χ(2) test was used respectively to compare the data between two groups. Cox regression was adopted to improve the single factor and multiple factors analysis. Results: The results of hybridization in situ showed the expression of miR-1178 was increased in 72 cases with pancreatic cancer compared to that in paired normal pancreatic tissues (50/72 vs. 11/72, χ(2)=43.26, P<0.05). miR-1178 expression was positively associated with tumor lymph node stage (χ(2)=4.189, P=0.041). Univariate and multivariate analysis revealed that miR-1178 was an independent adverse prognostic indicator for patients with pancreatic cancer (HR=2.364, 95%CI: 1.114-5.019, P=0.025). Transwell assay indicated the over-expression of miR-1178 increased the number of AsPC-1 cells that penetrated the ECM-coated membrane (177.0±19.8 vs. 119.7±15.9)(χ(2)=8.21, P<0.05). For the in vivo experiment, overexpression of miR-1178 significantly promoted tumor growth, compared with control group (tumor volume: (5 122.4±760.2)mm(3) vs. (1 976.8±601.8)mm(3), t=2.413, P<0.05; tumor weight: (1.55±0.21)g vs. (0.67±0.17)g, t=2.960, P<0.05). Over-expression of miR-1178 down-regulated the expression of Stub1 and elevated the expression of FAK/MMP-9 signal pathway(P<0.05). Conclusions: MiR-1178 is overexpressed in pancreatic cancer, and is effective for predicting patients' prognosis. MiR-1178 regulate Stub1/FAK/MMP-9 signal pathway and promote the invasion of AsPC-1 cells.

[Developing laparoscopic pancreaticoduodenectomy step by step]

Laparoscopic pancreaticoduodenectomy (LPD) is one of the most complicated operations in laparoscopic field.After been widely reported nowadays, LPD has been cautiously regarded as feasible and safe for radically resection.At present, several large pancreatic surgery centers in China have successively carried out this kind of surgery, with over one thousand cases in all.However, partly due to its complexity and steep learning curve, this procedure only remains limited to a few selected large pancreatic centers.Large sample prospective random control test studies are still required.We suggest that in China, LPD should only be developed steadily and step by step by highly skilled open and laparoscopic surgeons who have minimally invasive concept, contrary to fears and could grasp technical expertise.

[Intracranial mixed germ cell tumor]

Objective: To study intracranial mixed germ cell tumor diagnosis and reasonable treatment strategy. Methods: Clinical data of 17 patients with intracranial mixed germ cell tumor in Tsinghua university Yuquan hospital from October 2012 to October 2016 were retrospective analysed, including the characteristics of the general, the serum tumor markers of AFP, β-HCG, and CEA, imaging findings, pathological results, treatment methods and prognosis. Results: There were 10 cases of male, 7 cases of female. The average age was (11.1±5.2) years old. Nine cases were gross total resection of lesions and 8 cases were subtotal resection of lesions. Eight cases (47.1%) were without recurrence and had more than four courses of chemotherapy after surgery, of which, 7 cases belonged to the gross total resection, and 1 case belonged to the subtotal resection. Nine (52.9%) patients relapsed, including 2 cases of the gross total resection and 7 cases of the subtotal resection. Among them, 4 cases were given second operations and 6 cases obtained satisfactory therapeutic effect by chemotherapy combined radiotherapy. There were 12 of 17 patients with pathological types contain teratoma (including mature, immature or malignant teratoma) ingredients, accounting for 70.6%. The average follow-up time was (17.5±12.1) months, 4 cases (23.5%) patients died. Conclusion: The diagnosis of intracranial mixed germ cell tumors needs comprehensive consideration of tumor markers in serum or cerebrospinal fluid, chemotherapy and radiotherapy before operation and pathological results. The gross total resection helps to reduce the chances of tumor recurrence. Rational chemotherapy and radiotherapy is helpful to prognosis.

[Intracranial mixed germ cell tumor]

Objective: To study intracranial mixed germ cell tumor diagnosis and reasonable treatment strategy. Methods: Clinical data of 17 patients with intracranial mixed germ cell tumor in Tsinghua university Yuquan hospital from October 2012 to October 2016 were retrospective analysed, including the characteristics of the general, the serum tumor markers of AFP, β-HCG, and CEA, imaging findings, pathological results, treatment methods and prognosis. Results: There were 10 cases of male, 7 cases of female. The average age was (11.1±5.2) years old. Nine cases were gross total resection of lesions and 8 cases were subtotal resection of lesions. Eight cases (47.1%) were without recurrence and had more than four courses of chemotherapy after surgery, of which, 7 cases belonged to the gross total resection, and 1 case belonged to the subtotal resection. Nine (52.9%) patients relapsed, including 2 cases of the gross total resection and 7 cases of the subtotal resection. Among them, 4 cases were given second operations and 6 cases obtained satisfactory therapeutic effect by chemotherapy combined radiotherapy. There were 12 of 17 patients with pathological types contain teratoma (including mature, immature or malignant teratoma) ingredients, accounting for 70.6%. The average follow-up time was (17.5±12.1) months, 4 cases (23.5%) patients died. Conclusion: The diagnosis of intracranial mixed germ cell tumors needs comprehensive consideration of tumor markers in serum or cerebrospinal fluid, chemotherapy and radiotherapy before operation and pathological results. The gross total resection helps to reduce the chances of tumor recurrence. Rational chemotherapy and radiotherapy is helpful to prognosis.

[Attach importance to the multidisciplinary diagnosis and treatment of pancreatic cancer]

With the development of medicine, multidisciplinary team has become an important way of diagnosis and treatment of pancreatic cancer.In the paper, the definition of multidisciplinary team mode and the experiences of management of multidisciplinary team are discussed to further improve the level of multidisciplinary diagnosis and treatment of pancreatic cancer.More and more patients will be benifited from multidisciplinary team in China.

An ultrasensitive SERS sensor for simultaneous detection of multiple cancer-related miRNAs

Simultaneous detection of multiple trace cancer associated serum miRNA biomarkers is considered as a feasible method for early cancer screening and diagnosis. In the present work, an ultrasensitive SERS sensor was prepared based on an Ag nanorod array SERS substrate by assembling special hairpin-shaped molecular beacons (MBs) for the detection of multiple lung cancer-related miRNA biomarkers. The portable SERS sensor exhibits excellent performance for the qualitative and quantitative detection of miRNAs, with advantages of ultra-sensitivity, good specificity, uniformity, reproducibility and stability, as well as remarkable reusability. By monitoring the SERS signal quenching of the MBs in the presence of target miRNA biomarkers, three lung cancer related-miRNAs (miRNA-21, miRNA-486, and miRNA-375) in buffer and human serum were simultaneously assayed using the SERS sensor array, and the limits of detection of the three miRNAs in human serum are 393 aM, 176 aM, and 144 aM, respectively. The reliable results demonstrate that the proposed SERS sensor array can be a promising candidate with great potential for the screening and clinical diagnosis of cancer in the early stage.

[Expression of chemokine like factor-like myelin and lymphocyte and related proteins for vesicle trafficking and membrane link transmembrane domain-containing protein 2 in rats with varicocele]

OBJECTIVE

To investigate whether chemokine like factor (CKLF)-like myelin and lymphocyte and related proteins for vesicle trafficking and membrane link (MARVEL) transmembrane domain-containing protein 2 (CMTM2) is involved in spermatogenesis in varicocele induced subfertility rats and to discuss the possible mechanisms.

METHODS

Forty male SD rats (body weight: 220-330 g, age: 6-7 weeks) were randomly divided into 4 groups: varicocele for 4 weeks, varicocele for 12 weeks, sham operation for 4 weeks and sham operation for 12 weeks, with 10 rats in each group. These rats were introduced by partially ligating left kidney veins for the experimental groups, and the sham surgery groups as controls were executed with exactly the same surgery as in the experimental groups except for the ligation. The rats in control and experimental groups for 4 and 12 weeks were killed after laparotomy at the end of 4 and 12 weeks, respectively, the left testes and epididymis were taken out for counting the sperm, observing the seminiferous tubule change and immunochemistry for CMTM2. The changes included sperm density and motility, the outer diameter and inner diameter change and the changes of epithelium and the CMTM2 expression in immunochemistry.

RESULTS

Compared with the control groups, the sperm density [(63.9±7.1)×10⁶/mL vs.(74.3±5.0)×10⁶/mL] and motility [(58.7%±7.9%) vs.(66.1%±4.3%)] were reduced slightly in group of varicoele for 4 weeks, respectively (t=1.432, 1.563; P=0.076, 0.059, respectively). Varicocele significantly caused a decrease in sperm concentration [(40.5±7.2) ×10⁶/mL vs.(71.1±4.5)×10⁶/mL] and motility [(35.2%±8.5%)vs. (63.4%±4.1%)] at 12 weeks, compared with the related sham groups (t=3.754, 3.933; P=0.004, 0.002, respectively). Additionally, testis CMTM2 exhibited the same disparity, that is, the CMTM2 protein expression in varicocele group was significantly reduced, with the ratio of sham group to varicocele group at the end of 12 weeks 2.3±0.4 (t=1.978; P=0.039). In the evaluation of seminiferous tubules diameter, the external [(198.2±10.2) μm vs. (255.8±12.7) μm, t=2.125, P=0.003] and epithelium diameter [(54.1±1.5) μm vs. (75.5±4.1) μm, t=2.246, P=0.021] were decreased compared with the sham-related groups and previous varicocele groups. In all the varicocele groups, all types of sperm motility decreased compared with the related sham-operated group (P<0.05).

CONCLUSION

This study suggests varicocele has a detrimental effect on CMTM2 levels and decreases spermatogonia cell number, seminiferous tubules diameter, and sperm indices. CMTM2 is associated with sperm changes in rats with varicocele, and further studies are needed to study the mechanism.

Therapeutic Effect of Chang'an I Recipe ( I ) on Irritable Bowel Syndrome with Diarrhea: A Multicenter Randomized Double-Blind Placebo-Controlled Clinical Trial

OBJECTIVE

To evaluate the efficacy and safety of Chinese medicine (CM) decoction Chang'an I Recipe ( I ) in the treatment of irritable bowel syndrome with diarrhea (IBS-D).

METHOD

A multicenter, randomized, double-blind, placebo-controlled clinical trial was designed. Based on the order of inclusion, the IBS-D patients were randomly assigned to the treatment group or the placebo control group, administrated with Chang'an I Recipe or placebo, 150 mL/bag, 3 times daily, for 8 weeks. The primary indices of efficacy included the effective rates of IBS symptom severity score (IBS-SSS) and the differences in adequate relief (AR) responder; the secondary indexes of efficacy included the changes in scores of the IBS Quality of Life (IBS-QOL) and Hospital Anxiety and Depression (HAD) scales. The safety indices included adverse events and related laboratory tests.

RESULTS

A total of 216 patients were included, with 109 in the treatment group and 107 in the control group, and finally 206 were included in the full analysis set (FAS), 191 were included in the per protocol set (PPS). In FAS, the total effective rate was 67.6% and 40.2% for the treatment and control groups, respectively, with 95% confidence interval (CI) for difference in the effective rates between the two groups of 14.4%-40.2%; while in PPS, the total effective rate was 71.3% and 41.2% for the treatment and control groups, respectively (95% CI 16.6%-43.4%). The consistent conclusions of FAS and PPS showed a better efficacy in the treatment group. Both FAS and PPS showed higher AR responder in the treatment group (FAS: 59.6% vs. 35.5%; PPS: 62.8% vs. 38.1%). As for IBS-QOL, the total score and scores in various dimensions of IBS-QOL were not significantly different between the two groups (P>0.05). Both anxiety and depression scales of HAD were not significantly different between the two groups (P>0.05). No adverse events or laboratory abnormalities were found to be obviously related to the tested drugs or clinically significant.

CONCLUSION

Chang'an I Recipe was more effective than placebo in the treatment of IBS-D, with no obvious adverse reactions. (No.ChiCTR-TRC-09000328).

Molecular Changes Involving MEK3-p38 MAPK Activation in Chronic Masticatory Myalgia

The exact mechanism underlying chronic masticatory myalgia (CMM), a conspicuous symptom in temporomandibular disorders, remains unclear. This investigation compared gene expression profiles between CMM patients and healthy subjects. Peripheral blood leukocytes were collected in 8 cases and 8 controls and subjected to whole genome microarray analyses. Data were analyzed with Gene Ontology and interactive pathways analyses. According to Gene Ontology analysis, categories such as ion transport, response to stimuli, and metabolic process were upregulated. The pathway analysis suggested overexpression of the mitogen-activated protein kinase (MAPK) pathway in CMM patients and to a higher degree in a pathway network. Overexpression of representative members of the MAPK pathway-including MAPK kinase 3 (MEK3), calcium voltage-gated channel auxiliary subunit gamma 2 (CACNG2), and growth arrest and DNA damage-inducible gamma (GADD45G)-was validated with real-time polymerase chain reaction. The upregulation of MEK3 was negatively correlated with the age of the CMM group. In the next step, the authors focused on MEK3, the gene that exhibited the greatest degree of differential expression, and its downstream target protein p38 MAPK. The results revealed upregulation of MEK3, as well as phosphorylated MEK3 and phosphorylated p38 MAPK, in CMM patients. These results provide a "fingerprint" for mechanistic studies of CMM in the future and highlight the importance of MEK3-p38 MAPK activation in CMM.

[Diagnosis and treatment of solid pseudopapillary neoplasms of the pancreas]

Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare neoplasm which primarily affects young women without specific clinical manifestation. Computed tomography and magnetic resonance imaging contribute to the preoperative diagnosis of SPN. Surgery is the main treatment approach for SPN and more research of radiation and chemotherapy is needed. Tumor diameter larger than 5 cm, tumor infiltrating nerve, vessel or adipose tissue can increase the risk of recurrence. However, these patients can still get good prognosis after surgical resection.

[Effect of standardized treatment on reactivity of toe microcirculation in patients with type 2 diabetes mellitus]

OBJECTIVE

To evaluate the effect of standardized treatment on reactivity of the lower limb terminal microcirculation in patients with type 2 diabetes mellitus (T2DM) by high frequency ultrasound combined with warm bath.

METHODS

A total of 66 patients with T2DM were collected from June 2014 to May 2015 in the Second Affiliated Hospital of Wenzhou Medical University.According to the vascular complications , the patients were divided into group A without complications (36 cases)and group B with complications (30 cases). Hemodynamic parameters such as peak systolic velocity(PSV), end-diastolic velocity(EDV) and resistance index(RI) of the right plantar digital artery on fibular side of the 1st toe were acquired through Doppler in all subjects.Then the above operation were performed repetitively on all subjects after the right foot was immersed in 40 ℃ warm water for 5 minutes.The change rates of PSV, EDV and RI were calculated after warm bath.All subjects were examined again after three months treatment .The growth rates of the change rate of PSV, EDV and RI were calculated after treatment.All parameters were analyzed.

RESULTS

The change rates of the parameters in group B before and after treatment were lower than those of group A, before treatment (0.108±0.077 vs 0.184±0.091, P=0.037, 0.184±0.101 vs 0.380±0.167, P=0.002, 0.007±0.004 vs 0.015±0.008, P=0.028 7), after treatment (0.155±0.111 vs 0.421±0.138, 0.287±0.108 vs 0.794±0.286, 0.012±0.008 vs 0.039±0.014, P=0.000); the post treatment growth rates of the change rates of the parameters in group B were all less than those of group A (0.414±0.303 vs 2.192±2.673, P=0.048, 0.660±0.406 vs 1.422±1.075, P=0.042, 0.633±0.830 vs 2.191±2.269, P=0.048). The change rates of the parameters in two groups after treatment were higher than those before treatment (all P<0.05).

CONCLUSION

Warm bath test can be used to detect change degree of hemodynamic parameters in patients with T2DM so as to evaluate reactivity of blood microcirculation, which has a certain clinical application value in treatment.

[Surgical treatment of pancreatic carcinoma: problems and recent advances]

Nowadays surgical technologies develop fast under the guidance of minimally invasive medicine, evidence-based medicine, multi-disciplinary team and other ideas. However, the long-term outcome of pancreatic cancer remains dismal. In addition to the improvement of surgical resection rate, more attention should be paid to improve the overall survival rate of the patients with pancreatic cancer after surgery. Clinical studies of neoadjuvant therapies for the treatment of borderline resectable pancreatic cancer are advocated. Various types of pancreaticojejunostmy should be applied individually to improve the anastomosis quality and to reduce the postoperative complications. In the system of precision medicine, standardized surgical treatment pattern remains important.

[Expression of chemokine like factor-like myelin and lymphocyte and related proteins for vesicle trafficking and membrane link transmembrane domain-containing protein 2 in rats with varicocele]

OBJECTIVE

To investigate whether chemokine like factor (CKLF)-like myelin and lymphocyte and related proteins for vesicle trafficking and membrane link (MARVEL) transmembrane domain-containing protein 2 (CMTM2) is involved in spermatogenesis in varicocele induced subfertility rats and to discuss the possible mechanisms.

METHODS

Forty male SD rats (body weight: 220-330 g, age: 6-7 weeks) were randomly divided into 4 groups: varicocele for 4 weeks, varicocele for 12 weeks, sham operation for 4 weeks and sham operation for 12 weeks, with 10 rats in each group. These rats were introduced by partially ligating left kidney veins for the experimental groups, and the sham surgery groups as controls were executed with exactly the same surgery as in the experimental groups except for the ligation. The rats in control and experimental groups for 4 and 12 weeks were killed after laparotomy at the end of 4 and 12 weeks, respectively, the left testes and epididymis were taken out for counting the sperm, observing the seminiferous tubule change and immunochemistry for CMTM2. The changes included sperm density and motility, the outer diameter and inner diameter change and the changes of epithelium and the CMTM2 expression in immunochemistry.

RESULTS

Compared with the control groups, the sperm density [(63.9±7.1)×10(6)/mL vs.(74.3±5.0)×10(6)/mL] and motility [(58.7%±7.9%) vs.(66.1%±4.3%)] were reduced slightly in group of varicoele for 4 weeks, respectively (t=1.432, 1.563; P=0.076, 0.059, respectively). Varicocele significantly caused a decrease in sperm concentration [(40.5±7.2) ×10(6)/mL vs.(71.1±4.5)×10(6)/mL] and motility [(35.2%±8.5%)vs. (63.4%±4.1%)] at 12 weeks, compared with the related sham groups (t=3.754, 3.933; P=0.004, 0.002, respectively). Additionally, testis CMTM2 exhibited the same disparity, that is, the CMTM2 protein expression in varicocele group was significantly reduced, with the ratio of sham group to varicocele group at the end of 12 weeks 2.3±0.4 (t=1.978; P=0.039). In the evaluation of seminiferous tubules diameter, the external [(198.2±10.2) μm vs. (255.8±12.7) μm, t=2.125, P=0.003] and epithelium diameter [(54.1±1.5) μm vs. (75.5±4.1) μm, t=2.246, P=0.021] were decreased compared with the sham-related groups and previous varicocele groups. In all the varicocele groups, all types of sperm motility decreased compared with the related sham-operated group (P<0.05).

CONCLUSION

This study suggests varicocele has a detrimental effect on CMTM2 levels and decreases spermatogonia cell number, seminiferous tubules diameter, and sperm indices. CMTM2 is associated with sperm changes in rats with varicocele, and further studies are needed to study the mechanism.