Overcoming Drug Resistance in Colon Cancer by Aptamer-Mediated Targeted Co-Delivery of Drug and siRNA Using Grapefruit-Derived Nanovectors

BACKGROUND/AIMS

Multidrug resistance (MDR) is the most common cause of chemotherapy failure. Upregulation of P-glycoprotein (P-gp) is one of the main mechanisms underlying MDR.

METHODS

In this study, we developed a targeted drug and small interfering (si)RNA co-delivery system based on specific aptamer-conjugated grapefruit-derived nanovectors (GNVs) that we tested in MDR LoVo colon cancer cells. The internalization of nanovectors in cancer cells was tested by fluorescence microscopy and flow cytometry. The anti-cancer activity in vitro was determined by colony formation and cell apoptosis assays. The biodistribution of nanovectors was analyzed by live imaging and the anti-cancer activity in vivo was observed.

RESULTS

GNVs loaded with aptamer increased doxorubicin (Dox) accumulation in MDR LoVo cells, an effect that was abolished by pretreatment with DNase. The LA1 aptamer effectively promoted nanovector internalization into cells at 4°C and increased the targeted delivery of Dox to tumors. Constructs harboring Dox, LA1, and P-gp siRNA more effectively inhibited proliferation and enhanced apoptosis in cultured MDR LoVo cells while exhibiting more potent anti-tumor activity in vivo than free Dox or GNVs loaded with Dox alone or in conjunction with LA1, an effect that was associated with downregulation of P-gp expression.

CONCLUSION

This GNV-based system may be an effective strategy for overcoming MDR in clinical settings.

Decision analysis supports the use of drain amylase-based enhanced recovery method after esophagectomy

Postesophagectomy anastomotic leak is a common postsurgical complication. The current standard method of detecting leak is esophagram usually late in the postoperative period. Perianastomotic drain amylase level had shown promising results in early detection anastomosis leak. Previous studies have shown that postoperative day 4 amylase level is more specific and sensitive than esophagram. The purpose of this study is to determine if implementing a drain amylase-based screening method for anastomotic leak can reduce length of stay and hospital cost relative to a traditional esophagram-based pathway. The drain amylase protocol we propose uses postoperative day 4 drain amylase level to direct the initiation of PO intake and discharge. We designed a decision analysis tree using TreeAge Pro software to compare the drain amylase-based screening method to the standard of care, the esophagram. We performed a retrospective review of postesophagectomy patients from a tertiary academic medical center (University hospital Cleveland medical center) where amylase level was measured routinely postoperatively. The patients were separated into amylase-based pathway group and the standard of care group based on their postop management. The length of stay, costs, complications, and leak rate of these two groups were used to inform the decision analysis tree. In the base-case analysis, the decision analysis demonstrated that an amylase-based screening method can reduce the hospital stay by one day and reduced costs by ∼$3,000 compared to esophagram group. To take the variability of the data into consideration, we performed a Monte Carlo simulation. The result showed again a median saving of 0.71 days and ∼$2,500 per patient in hospital cost. A ballistic sensitivity analysis was performed to show that the sensitivity of postoperative day 4 amylase level in detecting a leak was the most important factor in the model. We conclude that implementing an amylase-based screening method for anastomotic leak in postesophagectomy patient can significantly reduce hospital cost and length of stay. This study demonstrates a novel protocol to improve postesophagectomy care. Based on this result, we believe a prospective multicenter study is appropriate.

The expression of circulating tumor cells in peripheral blood of patients with non-small cell lung cancer and its detection

This study aimed to investigate the expression of circulating tumor cells (CTCs) in peripheral blood and relevant detection methods as well as the clinical values of determination of CTCs for the diagnosis of non-small cell lung cancer (NSCLC). Peripheral blood specimens were acquired from the patients with NSCLC who came to the Thoracic Surgery Department of Jining No.1 People’s Hospital, Shandong, China for the first visit between January 2015 and November 2016. Whether there was metastasis of CTCs or not was determined by detecting the number of epithelial cell adhesion molecules (EpCAM) which had expression in the CTCs of the peripheral blood with fluorescence polymerase chain reaction. Moreover, the correlation between the expression level of EpCAM of patients with NSCLC during postoperative adjuvant treatment and the efficacy of adjuvant therapy was initially explored. The expression level of EpCAM of the NSCLC patients was remarkably different to that of the patients with benign lung diseases. The expression level of EpCAM of the patients with NSCLC was notably different with that of the healthy volunteers. The expression level of EpCAM of the patients with NSCLC was much higher than that of patients with benign lung diseases and the volunteers. Moreover, the expression level of NSCLC at stages I, II and IIIA had significant differences; the expression level of EpCAM tended to increase as the stage of NSCLC developed. The expression level of EpCAM in CTCs of peripheral blood can be regarded as a reference for the early diagnosis and detection of NSCLC before and after surgery.

Hyponatremia in neuromyelitis optica spectrum disorders: Literature review

Hyponatremia is a potentially serious electrolyte abnormality observed in neuromyelitis optica spectrum disorders (NMOSDs), and its most common cause is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Another potential cause of hyponatremia is cerebral salt-wasting syndrome (CSWS), although CSWS has not previously been reported in NMOSDs. Accurate and early differentiation between SIADH and CSWS is difficult. However, the two conditions have important implications for the selection of therapy. Here, we describe two patients with aquaporin-4 antibody (AQP4-Ab)-positive NMOSDs who developed hyponatremia as a result of CSWS and SIADH, respectively. Additionally, we review all previously reported studies of hyponatremia in patients with NMOSDs and propose several potential pathophysiological mechanisms of hyponatremia. In conclusion, NMOSDs accompanied by hyponatremia are not actually rare, but have previously been given little attention. Furthermore, SIADH should not be the only consideration, before the exclusion of rare but significant CSWS.

Impact of HBV genotype and mutations on HBV DNA and qHBsAg levels in patients with HBeAg-negative chronic HBV infection

BACKGROUND

HBV DNA and quantitative (q)HBsAg levels as prognostic markers for HBV-related disease are mostly validated in Asia and their significance in Western populations is uncertain.

AIM

To analyse the impact of the HBV genotype and frequent mutations in precore (PC), basal core promoter (BCP) and preS on HBV DNA and qHBsAg levels.

METHODS

HBV DNA and qHBsAg serum levels of 465 patients with HBeAg-negative chronic HBV infection were correlated with the HBV genotype and mutations in PC, BCP and preS. For a detailed analysis of the molecular virology, genotype A2 genomes harbouring these mutations were analysed for replication efficacy and HBsAg release in cell culture.

RESULTS

While no impact of the HBV genotype on HBV DNA levels was observed, qHBsAg levels differed up to 1.4 log among the genotypes (P < 0.001), reflected by large differences regarding the 1000 IU/mL HBsAg cut-off. While PC mutations were associated with higher (P < 0.001), BCP mutations were associated with lower HBV DNA levels (P < 0.001). Higher qHBsAg levels were associated with preS and lower levels with PC mutations (P < 0.001 and P = 0.001, respectively). The cell culture experiments revealed a higher HBsAg release and shorter filaments in case of a HBV genome harbouring a preS deletion. In contrast, a perinuclear HBsAg accumulation was detected for the PC and BCP-variants, reflecting an impaired HBsAg release.

CONCLUSIONS

qHBsAg serum levels depend on the HBV genotype and together with HBV DNA levels on frequent mutations in PC, BCP and preS in HBeAg-negative patients. qHBsAg cut-offs when used as prognostic markers require genotype-dependent validation.

[Prognostic significance of early assessment of minimal residual disease in acute myeloid leukemia with mutated NPM1 patients]

目的

探讨NPM1突变阳性急性髓系白血病（AML）患者化疗后早期微小残留病（MRD）水平与预后的关系。

方法

回顾性分析137例初治成人伴NPM1基因主要突变（A、B、D突变）AML患者的治疗结果，以及化疗后早期时间点MRD（NPM1突变转录本）水平对预后的影响。

结果

在137例患者中，男67例（48.9%），中位年龄49（16~67）岁，染色体正常核型107例（78.1%），FLT3-ITD突变阳性57例（41.6%），初诊时NPM1基因突变转录本中位水平84.1%（4.1%~509.9%）。在134例可评估的患者中，115例（85.8%）最终获完全缓解（CR）。多因素分析显示，WBC<100×10⁹/L（OR=0.3，95% CI 0.1~0.9，P=0.027）和初始诱导治疗为“IA10”方案（OR=0.3，95% CI 0.1~0.8，P=0.015）是获得CR的有利因素。在108例可评估的CR患者中，存活患者中位随访24（2~91）个月，3年无病生存（DFS）和总生存（OS）率分别为48.0%和63.9%。多因素分析显示，FLT3-ITD突变阳性（HR=3.2，95% CI 1.6~6.7，P=0.002）、巩固治疗2个疗程后MRD高水平（NPM1突变转录本水平较治疗前下降<3个对数级，HR=23.2，95% CI 7.0~76.6，P<0.001）、未接受异基因造血干细胞移植（allo-HSCT）（HR=2.6，95% CI 1.0~6.6，P=0.045）是影响患者DFS的不利因素；MRD在首次获得CR时高水平（NPM1突变转录本水平下降<2个对数级，HR=2.5，95% CI 1.0~6.1，P=0.040）和巩固治疗2个疗程后高水平（HR=4.5，95% CI 2.0~10.3，P<0.001）是影响患者OS的不利因素。进一步分析78例接受化疗（或自体移植）的CR患者，3年DFS和OS率分别为39.7%和59.1%，FLT3-ITD突变阳性和巩固治疗2个疗程后MRD高水平是独立影响患者DFS（HR=3.5，95% CI 1.6~7.6，P=0.002和HR=8.9，95% CI 3.8~20.7，P<0.001）和OS（HR=2.7，95% CI 1.1~6.9，P=0.036和HR=3.1，95% CI 1.2~8.0，P=0.021）的共同不利因素，此外，首次获得CR时MRD高水平（HR=3.1，95% CI 1.2~8.0，P=0.022）也是影响患者OS的不利因素。

结论

在NPM1突变阳性AML患者中，伴有FLT3-ITD突变和化疗后早期MRD高水平预示不良预后。

Downregulation of RPN2 induces apoptosis and inhibits migration and invasion in colon carcinoma

The morbidity of colorectal cancer (CRC) increases annualy, which accounts to higher mortality worldwide. Therefore, it is important to study the pathogenesis of colon cancer. Ribophorin II (RPN2), part of the N-oligosaccharyltransferase complex, is highly expressed in CRC. In the present study, we investigated whether RPN2 can regulate apoptosis, migration and invasion by RNA interference in CRC and sought to clarify the molecular mechanism involved. Based on previous research, an abnormal high expression of RPN2 was observed in CRC tissues and cell lines by real-time (RT)-PCR, immunohistochemistry (IHC) and western blot analysis. RPN2 knockdown via small RNA interference (siRNA) strategy attenuated the expression of RPN2 at the mRNA and protein levels in vivo, leading to decreased cell viability and increased cell apoptosis. In addition, RNAi-RPN2 effectively arrested the cell cycle at the G0/G1-phase in SW1116 and SW480 cells. Furthermore, the Transwell assay demonstrated that cell migration and invasion abilities were significantly inhibited after cell transfection with RPN2 interference plasmid. The apoptosis-related protein (caspase-3) expression was increased and the cell cycle-related protein (cyclin D1) expression was decreased in the siRNA-RPN2 group. RT-PCR and western blot analysis results indicated that migration- and invasion-related proteins including E-cadherin, matrix metalloproteinases (MMP)-2 and TIMP-2 were markedly regulated by RPN2 siRNA. Phosphorylation levels of signal transducer and activator of transcription (STAT)3 and Janus kinase (JAK)2 were inhibited by RPN2 siRNA. These findings indicated a novel pathway of tumor-promoting activity by RPN2 in CRC, with significant implications for unraveling the tumorigenesis of CRC.

[Study on the current status of smoking, intention of tobacco concession and related risk factors among 18-65-year olds patients with chronic diseases in Beijing]

Objective: To understand the status, attitude and related risk factors on smoking among 18-65 years old patients with hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) or asthma in Beijing. Methods: Data was gathered from the 2014 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified cluster sampling method was used and 19 815 participants aged 18-65 were sampled from 16 districts in Beijing. Results: Among all the 18 405 participants, male hypertensive patients showed a higher rate on current smoking than the other groups (χ(2)=17.695, P<0.001). Male patients with dyslipidemia had higher current smoking rate than the other groups (χ(2)=39.292, P<0.001). However, female patients with COPD or with asthma showed higher rate on current smoking than the other groups (χ(2)=6.276, P=0.012), (χ(2)=8.245, P=0.004). Among the smokers, hypertensive patients presented lower rate (χ(2)=20.487, P<0.001) on intention of smoking concession, than the other groups. Patients with COPD showed greater intention in quitting smoking (χ(2)=6.085, P=0.048), than the other groups. Male patients with diabetes (χ(2)=9.219, P=0.010) or dyslipidemia (χ(2)=13.513, P=0.001) who had stopped smoking tobacco appeared having higher rates in keeping the current status. Results from logistic regression analyses showed that smoking was the risk factor for hypertension (OR=1.17), dyslipidemia (OR=1.25), COPD (OR=1.78), and asthma (OR=1.57). Conclusions: Patients with certain kinds of chronic diseases showed higher rate of current smoking and lower rate of quitting. Cigarette consumption appeared an important risk factor for patients with hypertension, dyslipidemia, COPD, or asthma in Beijing.

[Outcomes of adult patients with de novo acute myeloid leukemia received idarubicin plus cytarabine regimen as induction chemotherapy]

Objective: To explore outcomes in adult with de novo acute myeloid leukemia (AML) received IA10 (10 mg/m(2) d1-3 idarubicin plus cytarabine 100 mg/m(2) d1-7) regimen as induction chemotherapy. Methods: From January 2008 to February 2016, data of consecutive newly-diagnosed AML (non-M(3)) adults treated with IA10 who achieved morphologic leukemia-free state (MLFS) but not accepted allogeneic hematopoietic stem cell transplantation (allo-HSCT) were assessed retrospectively. Results: A total of 198 patients were included in this study with 96 (48.5%) male and a median age of 42 years old (range, 18-62 years old). Using the SWOG cytogenetic classification, 45 (22.7%), 104 (52.5%), 24 (12.1%) and 25 (12.6%) patients belonged to favorable, intermediate, unfavorable and unknown categories, respectively. 6 (3.0%) patients had monosomal karyotype, and 28 (14.1%) positive FLT3-ITD mutation. A complete remission (CR, defined as MLFS with ANC ≥ 1×10(9)/L and PLT ≥ 100×10(9)/L) achieved in 168 (84.8%) patients, a CRp (defined as MLFS with incomplete PLT recovery) in 16 (8.1%) and a CRi (defined as MLFS with incomplete ANC and PLT recovery) in 14 (7.1%). With a median follow-up period of 15 months (range, 1 to 70 months) in survivors, the probabilities of cumulative incident of relapse (CIR), disease free survival (DFS) and overall survival (OS) rates at 2-year were 45.2%, 46.9% and 62.9%, respectively; the median durations of relapse, DFS and OS were 34, 20 and 37 months respectively. At the time of achieving first MLFS, multivariate analyses showed that positive FLT3-ITD mutation and CRi were common adverse factors affecting CIR, DFS and OS; unfavorable-risk of SWOG criteria was an adverse factor affecting CIR and DFS; monosomal karyotype was associated with shorter OS. After first consolidation therapy, FLT3-ITD mutation positive and unfavorable-risk of SWOG criteria had negatively impact on CIR, DFS and OS; peripheral blasts ≥ 0.50 and positive MRD (defined as RQ-PCR WT1 mRNA ≥ 0.6% or any level of abnormal blast population detected by flow cytometry) after first consolidation therapy were common adverse factors affecting CIR and DFS; CRi was an adverse factor affecting DFS and OS. Conclusions: In adult with de novo AML received IA10 regimen as induction regimen, unfavorable molecular markers or cytogenetics at diagnosis and CRi independently predicted poor outcome. In addition, a higher percentage of peripheral blasts, monosomal karyotype and positive MRD after first consolidation therapy had negatively impact on outcomes.

[Factors associated with early treatment response in adults with acute myeloid leukemia]

Objective: To explore the factors influencing early treatment responses in adult with de novo acute myeloid leukemia (AML) . Methods: Data of consecutive newly-diagnosed AML (non-acute promyelocytic leukemia) adults were analyzed retrospectively. To assess the impact of clinical characteristics at diagnosis and induction regimen on achieving morphologic leukemia-free state (MLFS) , blood counts and minimal residual leukemia (MRD, positive MRD defined as RQ-PCR WT1 mRNA ≥0.6% and/or any level of abnormal blast population detected by flow cytometry) at the time of achieving MLFS. Results: 739 patients were included in this study. 406 (54.9%) patients were male, with a median age of 42 years (range, 18-65 years) . In the 721 evaluable patients, MLFS was achieved in 477 (66.2%) patients after the first induction regimen and 592 (82.1%) within two cycles. A total of 634 patients (87.9%) achieved MLFS, including 534 (84.2%) achieving a complete remission (CR, defined as MLFS with ANC ≥ 1×10(9)/L and PLT ≥ 100×10(9)/L) , 100 (15.8%) achieving a CRi (defined as MLFS with incomplete ANC or PLT recovery) , respectively. 260 (45.9%) patients of 566 (89.3%) who detected MRD at the time of achieving MLFS had positive MRD. Multivariate analyses showed that female gender, favorable-risk of SWOG criteria, IA10 and HAA/HAD as induction regimen were factors associated with achieving early MLFS. In addition, low bone marrow blasts, HGB ≥ 80 g/L, PLT counts<30×10(9)/L and mutated NPM1 without FLT3-ITD were factors associated with achieving MLFS after the first induction regimen; Negative FLT3-ITD mutation was factor associated with achieving MLFS within two cycles. PLT counts ≥30×10(9)/L and IA10, IA8 or HAA/HAD as induction chemotherapy were factors associated with achieving CR. Female gender, favorable-risk of SWOG criteria, FLT3-ITD mutation negative, mutated NPM1 without FLT3-ITD were factors associated with negative MRD. Conclusions: Female gender, favorable molecular markers or cytogenetics, and standard-dose induction regimen were key factors associated with higher probability of early and deep responses in adults with AML.

[Effects of retroperitoneal laparoscopic ureterolithotomy and flexible-ureteroscopic holmium laser lithotripsy for complex upper ureteral calculi]

Objective: To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. Methods: A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ(2)test. Results: The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ(2)=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ(2)=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Conclusions: Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.

3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in the Preoperative Evaluation of Gliomas

BACKGROUND AND PURPOSE

Previous studies showed conflicting results concerning the value of CBF maps obtained from arterial spin-labeling MR imaging in grading gliomas. This study was performed to investigate the effectiveness of CBF maps derived from 3D pseudocontinuous arterial spin-labeling in preoperatively assessing the grade, cellular proliferation, and prognosis of gliomas.

MATERIALS AND METHODS

Fifty-eight patients with pathologically confirmed gliomas underwent preoperative 3D pseudocontinuous arterial spin-labeling. The receiver operating characteristic curves for parameters to distinguish high-grade gliomas from low-grade gliomas were generated. Pearson correlation analysis was used to assess the correlation among parameters. Survival analysis was conducted with Cox regression.

RESULTS

Both maximum CBF and maximum relative CBF were significantly higher in high-grade gliomas than in low-grade gliomas (P < .001). The areas under the curve for maximum CBF and maximum relative CBF in distinguishing high-grade gliomas from low-grade gliomas were 0.828 and 0.863, respectively. Both maximum CBF and maximum relative CBF had no correlation with the Ki-67 index in all subjects and had a moderate negative correlation with the Ki-67 index in glioblastomas (r = -0.475, -0.534, respectively). After adjustment for age, a higher maximum CBF (P = .008) and higher maximum relative CBF (P = .005) were associated with worse progression-free survival in gliomas, while a higher maximum relative CBF (P = .033) was associated with better overall survival in glioblastomas.

CONCLUSIONS

3D pseudocontinuous arterial spin-labeling-derived CBF maps are effective in preoperative evaluation of gliomas. Although gliomas with a higher blood flow are more malignant, glioblastomas with a lower blood flow are likely to be more aggressive.

Targeting PP2A activates AMPK signaling to inhibit colorectal cancer cells

LB-100 is a novel PP2A inhibitor. Its activity in human colorectal cancer (CRC) cells was tested. The in vitro studies demonstrated that LB-100 inhibited survival and proliferation of both established CRC cells (HCT-116 and HT-29 lines) and primary human colon cancer cells. Further, LB-100 activated apoptosis and induced G1-S cell cycle arrest in CRC cells. LB-100 inhibited PP2A activity and activated AMPK signaling in CRC cells. AMPKα1 dominant negative mutation, shRNA-mediated knockdown or complete knockout (by CRISPR/Cas9 method) largely attenuated LB-100-induced AMPK activation and HCT-116 cytotoxicity. Notably, microRNA-17-92-mediated silence of PP2A (regulatory B subunit) also activated AMPK and induced HCT-116 cell death. Such effects were again largely attenuated by AMPKα mutation, silence or complete knockout. In vivo studies showed that intraperitoneal injection of LB-100 inhibited HCT-116 xenograft growth in nude mice. Its anti-tumor activity was largely compromised against HCT-116 tumors-derived from AMPKα1-knockout cells. We conclude that targeting PP2A by LB-100 and microRNA-17-92 activates AMPK signaling to inhibit CRC cells.

[Value of endoscopic ultrasound in early diagnosis of gastroesophageal varices in patients with liver cirrhosis]

Objective: To investigate the value of endoscopic ultrasound in the early diagnosis of gastroesophageal varices in patients with liver cirrhosis. Methods: A total of 74 patients with liver cirrhosis who were not found to have esophageal or gastric varices by conventional endoscopic examination were enrolled. Endoscopic ultrasound was performed to evaluate its value in the early diagnosis of gastroesophageal varices in patients with liver cirrhosis. The Mann-Whitney U test was used for comparison of non-parametric data between groups, and a one-way analysis of variance was used for comparison between multiple groups; the Pearson simple correlation coefficient was used for correlation analysis. Results: Among the 74 patients with liver cirrhosis, 3(4.1%)were not found to have esophageal and gastric submucosal varices, peripheral varices, or perforating branches by endoscopic ultrasound. Among the 71 patients with liver cirrhosis who underwent endoscopic ultrasound, 16(22.5%)had esophageal submucosal varices, and 22(31.0%)had gastric submucosal varices; 58 patients(81.7%)were found to have at least one type of esophageal peripheral varices. The numbers of patients detected to have paraesophageal varices, periesophageal varices, paragastric varices, and perigastric varices were 29(40.8%), 24(33.8%), 28(39.4%), and 22(31.0%), respectively, which were significantly different from the number in patients with chronic liver diseases(P < 0.05). Among the 71 patients with liver cirrhosis who underwent endoscopic ultrasound, 20(28.2%)were found to have perforating branches with esophageal and gastric submucosal varices or peripheral varices, which showed a significant difference from the number in patients with chronic liver diseases(P < 0.05). In patients with liver cirrhosis, esophageal and gastric peripheral varices were associated with esophageal and gastric submucosal varices(P < 0.05). Conclusion: Endoscopic ultrasound has a certain value in the early diagnosis of esophageal and gastric varices in patients with liver cirrhosis.

Comparison of effectiveness and safety between conbercept and ranibizumab for treatment of neovascular age-related macular degeneration. A retrospective case-controlled non-inferiority multiple center study

Purpose

To compare the efficacy and safety of conbercept and ranibizumab when administered according to a treat-and-extend (TREX) protocol for the treatment of neovascular age-related macular degeneration (AMD) in China.

Patients and methods

Between May 2014 and May 2015, 180 patients were treated in a 1 : 1 ratio using conbercept or ranibizumab from four hospitals. Patients received either conbercept 0.5 mg or ranibizumab 0.5 mg intravitreal injections. Follow-up time was 1 year and treated based on a TREX approach. Main outcomes and measures include best-corrected visual acuity (BCVA), using Early Treatment Diabetic Retinopathy Study (ETDRS); number of injections; central retinal thickness (CRT); and leakage of choroidal neovascularization before and after the treatment was analyzed by fluorescein fundus angiography and indocyanine green angiography.

Results

The 1-year visit was completed by 168 (93.3%) of patients. Mean BCVA was equivalent between two cohorts, and were improved by 12.7±7.770 and 12.3±7.269 letters in the conbercept and ranibizumab cohorts, respectively (P=0.624). There was no significant difference in measured CRT, with a mean decrease of 191.5 μm for conbercept and 187.8 μm for ranibizumab (P=0.773). There was a statistically significant difference (P=0.001) between the drugs regarding the number of treatments: 7.4 for conbercept and 8.7 for ranibizumab. The difference in the distribution of injection intervals was statistically significant between two groups (P=0.011). During the study, there were no cases of endophthalmitis or intraocular inflammation.

Conclusion

Both drugs had equivalent effects in visual and anatomic gains at 1 year when administered. In the conbercept group, longer treatment intervals were achieved with more patients.

Delivery of a chemotherapeutic drug using novel hollow carbon spheres for esophageal cancer treatment

Low toxicity and high efficacy are the key factors influencing the real-world clinical applications of nanomaterial-assisted drug delivery. In this study, novel hollow carbon spheres (HCSs) with narrow size distribution were developed. In addition to demonstrating their ease of synthesis for large-scale production, we also demonstrated in vitro that the HCSs possessed high drug-loading capacity, lower cell toxicity, and optimal drug release profile at low pH, similar to the pH in the tumor microenvironment. The HCSs also displayed excellent immunocompatibility and could rapidly distribute themselves in the cytoplasm to escape lysosomal clearance. More importantly, the HCSs could efficiently deliver doxorubicin (a representative chemotherapeutic drug) to tumor sites, which resulted in significant inhibition of tumor growth in an esophageal xenograft cancer model. This also prolonged the circulation time and altered the biodistribution of the drug. In conclusion, this study revealed a novel drug delivery system for targeted tumor therapy.

[Minimal residual disease level predicts outcomes in the non-favorable risk patients with acute myeloid leukemia]

Objective: To explore impact of minimal residual leukemia (MRD) on outcomes in the non-favorable risk adults with de novo acute myeloid leukemia (AML) . Methods: From January 2008 to February 2016, data of consecutive newly-diagnosed non-favorable risk adults with AML (non-APL) according to SWOG criteria who achieved morphologic leukemia-free state (MLFS) and received continuous chemotherapy were assessed retrospectively. Results: 292 AML patients were enrolled, 150 (51.4%) were male. Median age was 46 years (range, 18-65 years) . Using the SWOG cytogenetic classification, 186 (63.7%) , 49 (16.8%) and 57 (19.5%) patients belonged to intermediate, unfavorable and unknown categories, respectively. With a median follow-up period of 15 months (range, 1 to 94 months) in survivors, the probabilities of cumulative rates of relapse (CIR) , disease free survival (DFS) and overall survival (OS) at 2-years were 51.6%, 42.6% and 60.0%, respectively. Multivariate analyses showed that MRD positive (defined as Q-PCR WT1 mRNA ≥0.6% or any level of abnormal blast population detected by flow cytometry) after achieving MLFS and PLT<100×10(9)/L were common adverse factors affecting CIR and DFS. In addition, positive FLT3-ITD mutation and CRp/CRi had negatively impact on CIR, DFS and OS. Monosomal karyotype was adverse factors affecting CIR and OS. Age ≥44 years and unfavorable-risk of SWOG criteria were associated with shorter DFS. Conclusions: MRD level after achieving MLFS had prognostic significance on outcomes in non-favorable adults with AML who received continuous chemotherapy after achieving MLFS.

[Prevalence of hypercholesterolemia and influence factors in residents aged 18-65 years in Beijing]

Objective: To understand the prevalence of hypercholesterolemia and related risk factors in residents aged 18-65 years in Beijing and provide scientific evidence for the prevention and control of hypercholesterolemia. Methods: The data were collected from Beijing Non-communicable and Chronic Disease Survey and stratified cluster sampling method was used to select study subjects, and questionnaire investigation, physical measurement and laboratory examination were conducted to collect information. Results: The prevalence of hypercholesterolemia and borderline hypercholesterolemia was 6.26% and 21.34% respectively in 17 662 residents surveyed, the average total cholesterol level was (4.69±0.95) mmol/L. The prevalence of hypercholesterolemia was 6.33% in men and 6.20% in women, the difference was not significant (Z=1.64, P=0.10). The prevalence was higher inurban area than in suburb (6.73% vs. 5.59%; Z=-7.27, P<0.01). The prevalence of hypercholesterolemia increased with age (trend χ(2)=308.85, P<0.01). The trend was observed in men (trend χ(2)=81.65, P<0.01), in women (trend χ(2)=318.04, P<0.01), in urban area (trend χ(2)=201.77, P<0.01) and in suburb (trend χ(2)=114.65, P<0.01). Multiple logistic regression showed age, being female (OR=1.23, 95%CI: 1.04-1.45), overweight (OR=1.56, 95%CI: 1.34-1.81), obesity (OR=1.82, 95%CI: 1.54-2.16), smoking (OR=1.24, 95%CI: 1.03-1.50), alcohol use (OR=1.40, 95%CI: 1.12-1.75), beef and mutton intake >1 time per week (OR=1.19, 95%CI: 1.02-1.39) were risk factors. Conclusion: The prevalence of hypercholesterolemia in Beijing was lower than national level, and age, gender, location, BMI, smoking, alcohol use, beef and mutton intake were main influencing factors.

[The comparation of fusion targeting biopsy and systematic biopsy in the clinical diagnosis of prostate cancer: a meta-analysis]

Objective: To systematically compare the differences in the detection rate of prostate cancer with fusion targeting biopsy and systemic biopsy. Methods: A computer-based search of PubMed, Medline, China Biomedical Literature Database and Wanfang database (from the beginning of establishment of library to October 2016) on the detection rate of prostate cancer by fusion targeting biopsy and systemic biopsy was performed manually.The inclusion and exclusion criteria were formulated by 2 reviewers, and the data were extracted and evaluated respectively. RevMan5.3 software was used to analyze the detection rate of prostate cancer by two biopsy methods. Results: A total of 15 related clinical studies were included, 5 337 cases were enrolled in the study, including 2 667 cases of targeted fusion biopsy and 2 670 cases of routine systemic biopsy. The results showed that the overall detection rate of prostate cancer in targeting fusion biopsy was significantly higher than that of conventional systemic biopsy (OR=1.16, 95% CI 1.04-1.30, P=0.007). The detection rates of prostate cancer with different risk grades by two biopsy methods were conducted. We found that targeted fusion biopsy had a significant advantage compared with conventional system biopsy (OR=1.37, 95% CI 1.19-1.58, P<0.05) in middle and high risk prostate cancer with Gleason ≥ 7 points. In low-risk prostate cancer patients with Gleason score <7, the detection rate of prostate cancer by targeted fusion biopsy was lower (OR=0.76, 95% CI 0.65-0.89, P<0.05) than that of conventional systemic biopsy. Conclusions: Targeted fusion biopsy was significantly better than systemic biopsy in the overall detection rate of prostate cancer and the detection rate of the middle and high risk prostate cancer with Gleason ≥7 points. However, systemic biopsy performed better in patients with Gleason<7 points of low-risk prostate cancer.

Correlation between circulating tumor cells EGFR expression and T cell subsets in advanced non-small cell lung cancer patients after tyrosine kinase inhibitor treatment

Research indicates that after EGFR-tyrosine kinase inhibitors (EGFR-TKIs) treatment of non-small cell lung cancer (NSCLC), patient immune function significantly improved, and that circulating tumor cells (CTCs) measurements and peripheral blood epidermal growth factor receptor (EGFR) mutation data can guide TKIs treatment. Sixty-six advanced NSCLC patients treated with TKIs were enrolled and CTCs, EGFR expression, T cell subsets and natural killer (NK) cells in peripheral blood were measured using flow cytometry before and after treatment and assessed with respect to patient prognosis. CTCs and EGFR expression were negatively correlated with cellular immune function and immune recovery after EGFR-TKI treatment. Thus, CD4+/ CD8+ ratios and NK cells may be useful prognostic indicators for advanced NSCLC patients who receive TKIs treatment.

The expression of SIRT3 in primary hepatocellular carcinoma and the mechanism of its tumor suppressing effects

OBJECTIVE

To observe the SIRT 3 expression in primary hepatocellular carcinoma (HCC), and then establish the eukaryotic expression vector of SIRT3 to observe the proliferation and apoptosis of pZsGreen-c1-SIRT3 HepG2 cells. Furthermore, we explored the mechanism of SIRT3 in inhibiting HCC.

PATIENTS AND METHODS

Immunohistochemistry was used to detect the expression of SIRT3 in the tumor tissue and para-tumor tissue in 32 patients with HCC and the normal liver tissue in 10 patients. The mRNA of SIRT3 from the normal liver tissue was used as a template, reverse transcription-polymerase chain reaction (RT-PCR) was used to obtain the total sequence of SIRT3 gene, and then the gene was cloned and combined with vector pZsGreen-c1, liposome transfection technology was used to transfect the recombined plasmid into HepG2. The cells were divided into three groups: group A (HepG2 cells as a blank control group), group B (pZsGreen-c1 HepG2 cells as an experimental control group) and group C (pZsGreen-c1-SIRT3 HepG-2 cells as an experimental group). MTT (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide) assay was used to detect the growth and proliferation of cells in 3 groups; annexinV/PI double staining was used to detect the apoptotic rates of cells in 3 groups. Western blot was used to detect the protein expression of SIRT3, Fas, Bax and P53, and water-soluble tetrazolium salt (WST-1) was used to detect MnSOD content in 3 groups.

RESULTS

Immunohistochemistry results showed that SIRT3 in the tumor tissue sample was positive in 19 patients out of 32 HCC patients; however, there was no strong positive case, the positive rate of SIRT3 expression was 59.38% (19/32). SIRT3 in the para-tumor tissue was positive in 31 HCC patients, the positive rate was 96.88% (31/32), and 18 cases were strongly positive; SIRT3 in normal liver tissue was positive in all 10 cases, the positive rate was 100.0% (10/10), and 7 cases were strongly positive. The differences of SIRT3 positive rate and positive score in tumor tissue from para-tumor tissue and normal liver tissue were statistically significant (p<0.05). However, the differences between para-tumor tissue and normal liver tissue were not statistically significant (p>0.05). After pZsGreen-c1-SIRT3 transfection, MTT results showed that the OD values in 3 groups were increased with the time, showing time-dependent manner. At 48 h after culture, the OD values in-group C were significantly different from group A and B, and the inhibitory rates were statistically different (p<0.05). After 48 h, the OD values and inhibitory rates in-group C showed that the cells were obviously inhibited, and the inhibitory rates were increased with the time, showing time-dependent manner. Flow cytometry results showed that the cell numbers of early stage apoptosis and late stage apoptosis were significantly increased in group C, which was significantly higher than group A and B, the differences were statistically significant (p<0.01). Western blot results showed that expression levels of SIRT3, p53, Bax and Fas were not different between group A and B (p>0.05); SIRT3, p53, Bax and Fas in group C were significantly increased, which were statistically higher than group A and B (p<0.01). WST-1 results showed that MnSOD contents were not statistically different between group A and B (p>0.01). MnSOD content in-group C was significantly higher than the other groups, which were statistically significant (p<0.01).

CONCLUSIONS

SIRT3 shows low expression or deficiency in HCC tissue, indicating that SIRT3 expression can affect the occurrence and development of HCC. SIRT3 can inhibit the growth and proliferation of HepG2 cells and induce HepG2 cell apoptosis. The mechanism may be related to the up-regulation of MnSOD and p53, the up-regulation of Bax and Fas by MnSOD.

Generalized R-squared for detecting dependence

Detecting dependence between two random variables is a fundamental problem. Although the Pearson correlation coefficient is effective for capturing linear dependence, it can be entirely powerless for detecting nonlinear and/or heteroscedastic patterns. We introduce a new measure, G-squared, to test whether two univariate random variables are independent and to measure the strength of their relationship. The G-squared statistic is almost identical to the square of the Pearson correlation coefficient, R-squared, for linear relationships with constant error variance, and has the intuitive meaning of the piecewise R-squared between the variables. It is particularly effective in handling nonlinearity and heteroscedastic errors. We propose two estimators of G-squared and show their consistency. Simulations demonstrate that G-squared estimators are among the most powerful test statistics compared with several state-of-the-art methods.

Feasibility and safety of peroral endoscopic myotomy for achalasia after failed endoscopic interventions

With advances in natural orifice transluminal endoscopic surgery, peroral endoscopic myotomy (POEM) has become a novel treatment for esophageal achalasia. In this study, we investigated the feasibility and safety of POEM in patients with achalasia after failed endoscopic interventions. Data on all patients undergoing POEM treatment of achalasia were collected prospectively. We enrolled 61 patients who underwent POEM for achalasia between July 2011 and January 2014. The preoperative intervention group included patients who had undergone botulinum toxin injection or pneumatic balloon dilation before POEM. The preoperative, operative, and short-term outcome data between the groups were compared. Among preoperative intervention group, 22 patients received endoscopic therapy before being referred for operation (18 dilation only, 2 botulinum toxin only, and 2 both treatments). Procedure time in the preoperative intervention group was similar to the nonpreoperative intervention group (60.8 ± 30.9 vs. 62.0 ± 21.0 minutes, P = 0.863). Both groups demonstrated significant improvement in Eckardt scores and manometric outcomes at 1-year follow-up. There were no significant differences in pretreatment and posttreatment D-values of symptom scores and lower esophageal sphincter pressures between groups (6.2 ± 2.2 vs. 6.1 ± 1.8, P = 0.840; 27.9 ± 17.6 vs. 24.9 ± 15.2; P = 0.569). There was also no significant difference in the incidence of intraoperative complications (P = 0.958) and gastroesophageal reflux rate (23.5% vs. 20.0%, P = 0.771) between the two groups. Our study demonstrated that POEM is safe and effective, even for treating achalasia in the setting of failed endoscopic interventions.

Recombinant beta interferon could clear the low-dose infected porcine reproductive and respiratory syndrome virus (PRRSV) in MARC-145 cells

Porcine reproductive and respiratory syndrome virus (PRRSV) causes one of the most economically devastating and pandemic porcine diseases. Previous study has shown that MARC-145 cells pretreated with recombinant IFN-β (rIFN-β) couldn't develop cytopathic effect (CPE) of PRRSV. However, up to date, it is not clear whether MARC-145 cells post-treated with rIFN-β could develop CPE of PRRSV. The present work showed that the MARC-145 cells didn't develop the CPE at 120 hr post-infection (p.i.) with low-dose of PRRSV when the cells were pre-treated with rIFN-β (Group 1), post-treated with rIFN-β at 4 hr p.i. (Group 2), or post-treated with rIFN-β at 8 hr p.i. (Group 3), while the MARC-145 cells could develop CPE when the cells were infected with high-dose PRRSV and then treated with rIFN-β at 24 hr p.i.. Furthermore, the indirect immunofluorescence assay confirmed that there were a few N protein-positive cells in the high-dose infected cells in Group 1, Group 2 and Group 3, while there were no N protein-positive cells in the low-dose infected cells in all rIFN-β treatment groups. In addition, the numbers of N protein-positive cells in high-dose infected cells (MOI = 10) in Group 1 were lower than that in Group 2 and Group 3. The results above demonstrated that both pre-treatment with rIFN-β and an earlier post-treatment with rIFN-β could inhibit the PRRSV replication and could clear the low-dose infected PRRSV, which indicated that the rIFN-β had efficient antiviral activities when the cells have been infected with PRRSV.

Beneficial effects of protein hydrolysates in exercise and sports nutrition

Protein hydrolysates (PH) are rich sources of proteins that supply the need of exercising muscles. PHs are enriched in di- and tripeptides and are better than free amino acids or intact proteins when muscle anabolic effect is considered. Digestion, absorption and muscle uptake of amino acids are faster and more efficient when PH is ingested in comparison to the respective intact protein. PHs not only enhance endurance in high intensity exercise regimen, but also help in faster post-exercise recovery of muscle by promoting glycogen synthesis, although the latter effect requires more convincing evidence. PHs have been shown to exhibit insulinotrophic effect as it enhances the secretion of insulin and the hormone, in turn, exerts muscle anabolic effect.

The motility of esophageal sphincters during liquid and solid bolus swallows: a multicenter normative value study of high-resolution manometry in China

BACKGROUND

It is gradually accepted that solid bolus swallow needs to be added to the procedure of manometry. The motility differences in the upper esophageal sphincter (UES) and lower esophageal sphincter (LES) were not well described. Sierra Scientific Instruments solid-state high-resolution manometry (HRM) system, the most popular HRM system in China, lacks the Chinese normative values for both liquid and solid bolus swallow parameters.

METHODS

The esophageal HRM data of 88 healthy volunteers were analyzed. The parameters of both sphincters in resting stage were summarized and those during solid and liquid swallows were compared.

KEY RESULTS

Normative HRM values of sphincter parameters in solid and liquid bolus swallows in China were established. The UES residual pressure of solid bolus swallows was lower than that of liquid bolus (0.3±5.5 mm Hg vs 4.8±5.9 mm Hg, P=.000). The time parameters of UES relaxation between two types of bolus swallows were similar. In solid bolus swallows, the intrabolus pressure (IBP) (13.8±5.1 mm Hg vs 10.9±5.7 mm Hg, P=.000) and LES relaxation time (11.0±2.1 seconds vs 8.7±1.3 seconds, P=.000) were higher. The 4-second integrated relaxation pressure between both bolus swallows was similar.

CONCLUSIONS & INFERENCES

The function of the UES and LES between solid and liquid bolus swallows is different. Chinese HRM parameters are different from the Chicago Classification (http://www.chictr.org.cn, Number ChiCTR-EOC-15007147).

[Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy]

Objective: To compare the effects of septal ablation (SA) versus conservative medication (CM) on the hemodynamic, clinical status and survival in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: This retrospective study included 350 consecutive patients with HOCM (mean age (51.3±13.5) years old) hospitalized in Anzhen Hospital between September 2002 to September 2014. The patients were followed up to 14 years and the follow up rate was 99.4% (348/350). Overall and cardiac-related mortalities were compared between SA group (n=184) and CM group (n=184). Moreover, SA related cardiac function and hemodynamics improvement were also evaluated, predictors for clinical events were evaluated by Cox regression analysis and Kaplan-Meier survival analysis was used to compare the total mortality between the two groups. The log-rank test was used to compare the survival curve differences between the two groups. Results: The median follow-up period was 4 years (1-14 years). The annual mortalities of SA and CM were 2.4% and 0.6% respectively (P<0.001) and cumulative sudden cardiac death (SCD)rates were 3.61% (6/166) and 0.54% (1/184) respectively (P=0.031). Multivariate regression analysis demonstrated that the age was the most important independent predictor for overall mortality(HR=1.259, 95%CI 1.101-1.438, P=0.001). In addition, left ventricular outflow tract (LVOT) gradient was significantly reduced post SA (peak velocity of LVOT: baseline (4.23±1.05) m/s, post SA: (1.83±0.79) m/s, P<0. 01) and heart function was also significantly improved post SA (NYHA at baseline: 2.97±0.29, post SA: 1.74±0.53, P<0.001). Conclusion: SA could significantly improve the hemodynamics and clinical status in drug-resistant patients with HOCM. In comparison to patients received CM, overall survival rate was significantly higher in SA group without extra risk of SCD.

[Inactivation of PMS2 gene by promoter methylation in nasopharyngeal carcinoma]

Objective: To investigate the inactivation of PMS2 gene mediated by promoter methylation and its regulatory mechanism in nasopharyngeal carcinoma (NPC). Methods: Fifty-four NPC tissues, 16 normal nasopharyngeal epithelia (NNE), 5 NPC cell lines (CNE1, CNE2, TWO3, HNE1 and HONE1) and 1 normal nasopharyngeal epithelial cell line (NP69) were collected.Methylation-specific PCR (MSP) was used to detect the PMS2 promoter methylation, semi-quantitative reverse transcription PCR (qRT-PCR) was applied to determine its mRNA expression, and immunohistochemistry (IHC) was used to detect the protein expression of PMS2. The expressions of PMS2 mRNA in CNE1 and CNE2 cells before and after treated with methyltransferase inhibitor 5-aza-2-deoxycytidine were analyzed by qRT-PCR. The impact of methylation and demethylation on the mRNA expression of PMS2, and the association of mRNA and protein expression of PMS2 with clinicopathological features of nasopharyngeal cancer were analyzed. Results: Methylation of PMS2 gene was detected in all of the five NPC cell lines, but not in normal nasopharyngeal epithelial NP69 cells. The methylation rate of PMS2 gene in NPC tissues was 63% (34/54), significantly higher than that of the normal nasopharyngeal epithelia (0/16, P<0.001). The expression levels of PMS2 mRNA and protein were significantly down-regulated in the 54 NPC tissues when compared with those in the 16 NNE tissues (P<0.001), and were also significantly lower in the 34 methylated NPC tissues than those in the 20 unmethylated NPC tissues (P<0.001). After treatment with 5-aza-2-deoxycytidine, the expression of PMS2 mRNA was restored in the CNE1 and CNE2 cells.However, the expressions of PMS2 mRNA and protein were not significantly correlated with patients' age, gender, TNM stage, histopathologic type or lymph node metastasis (P>0.05 for all). Conclusions: Promoter methylation-mediated inactivation of PMS2 gene participates in carcinogenesis and development of NPC. PMS2 may be a candidate tumor suppressor in the treatment for patients with inactivation of PMS2 promoter methylation.

[Clinical effect of compound internal fixations in treating extreme distal radial fractures]

Objective: To investigate the clinical character and treating strategy of extreme distal radial fractures. Methods: From June 2012 to May 2014, 12 patients who suffered from extreme distal radial fractures were treated in Department of Orthopedics, Tongji Hospital, Tongji University. According to AO/OTA classification, there were 4 cases of type 23B1, 3 cases of 23B2, 3 cases of 23C1 and 2 cases of 23C3.When classified by morphological features, there were 4 of simple styloid process fracture, 3 of simple extreme distal radial fracture without articular surface involved, 3 of styloid process fracture combined with distal radial articular fracture, and 2 of articular surface splintered or collapse fracture. According to the fracture features that radiographic exams showed, different surgical paths and fixation methods were chosen in order to protect soft tissues to the best advantage. To those patients with simple styloid process fracture, screw alone, Kirschner-wire or styloid plate were used for fixation. To the other types of fracture, open reduction and compound internal fixation with low-notch volar plate, dorsal or volar mini-plate, screw or Kirschner-wire was applied to ensure the stability of fixation, and maximally protect soft tissues like tendons, ligaments and neurovascular bundles, counting on the "stuffing-squeezing" effects after reduction or reconstruction of the articular surface. Situation of the wound and soft tissue were mainly checked in the first 2 weeks, and in the 3rd month post-operatively, fracture reduction and internal fixation were evaluated by radiographic methods like X-ray and CT scan. When 12 months post-operatively, not only radiographic follow-up such as fracture reduction, internal fixation and osteoarthritis were taken, but also some other evaluation, such as pain of wrist, rotation range of forearm, grip strength, and function of wrist according to DASH scores. Results: All of the 12 cases were followed up for at least 1 year. The wound healed well in all cases 2 weeks post-operatively, and no soft tissue infections, necrosis or neurovascular complications occurred. All fractures healed and no loss of reduction occurred 3 months post-operatively. Internal fixations were at good condition except in 2 cases, whose Kirschner-wire had been removed 2.5 and 2.8 months after the operation due to loosening and partly backing out on dorsal side. When followed up at 12 months post-operatively, one from these 2 patients suffered from a mild pain of wrist, and grip strength together with the function of the affected wrist dramatic declined when compared to the unaffected side. With the help of radiograph, local collapse on the articular surface was found, which meant to be traumatic arthritis. There were no pain in the rest 11 cases, and flexion-extension range of the wrist, rotation range of forearm and grip strength of the affected side recovered to over 80% of the unaffected side, with a DASH score was from 7 to 15 points(average 11.9 points)below 15 points. Conclusions: Traditional volar plates can not be used for extreme distal radial fractures. It may be an effective way to treat extreme distal radial fractures with compound internal fixation on the basis of morphological feature of fractures and the situation of soft tissue because of vivid of the fixation, reducing damage of soft tissue and early functional training.

[Inventory building of phages against extensively drug-resistant Acinetobacter baumannii isolated from wounds of patients with severe burn and related characteristic analysis]

OBJECTIVE

To build inventory of phages against extensively drug-resistant Acinetobacter Baumannii isolated from wounds of inpatients of burn ICU and analyze related characteristics.

METHODS

In 2014 and 2015, 131 strains of extensively drug-resistant Acinetobacter Baumannii were isolated from wounds of inpatients of burn ICU from one hospital in Chongqing. In 2015, 98 strains of extensively drug-resistant Acinetobacter Baumannii were isolated from wounds of inpatients of burn ICU from 6 hospitals in Guangdong province. Above-mentioned 229 strains were collected for conducting experiments as follows: (1) Multilocus sequence typing (MLST) of strains isolated from Chongqing and Guangdong province was analyzed. (2) Sewage co-culture method was applied for isolation of phages with above-mentioned strains and sewage from Chongqing and Guangdong province. Numbers of isolated phages and times of successful isolation and unsuccessful isolation were recorded. (3) The most prevalent subtypes of strains from Chongqing and Guangdong province in 2015 were collected, and their phages respectively underwent cross infection with all strains from Chongqing and those from Guangdong province. The lysis ability of phage was observed when phage underwent cross infection with the same subtype of strain or not the same, and the lytic ratio was calculated. (4) Fluid of phage in one type was randomly selected and equally divided into 3 parts, and its titer was determined by double dilution method. Then each part of phage fluid was subdivided into 3 small parts, which were cultured with LB fluid medium and respectively stored under the condition of -20 ℃, 4 ℃, and room temperature. After being stored for 1 month and 2 months, the titer of phage was determined for evaluating stability of phage. Data were processed with Fisher's exact test, chi-square test, and one-way analysis of variance.

RESULTS

(1) The major type of strains from Chongqing in 2014 was ST368 (45%, 31/69), and major types of strains from Chongqing in 2015 were ST75 (26%, 16/62) and ST195 (24%, 15/62), while that from Guangdong province in 2015 was ST977 (46%, 45/98). (2) For strains from Chongqing, isolation effect of phage with sewage of Chongqing (8 times of successful isolation with 9 strains of phages and 1 time of unsuccessful isolation) was better than that with sewage of Guangdong province (1 time of successful isolation with 1 strain of phage and 7 times of unsuccessful isolation). For strains from Guangdong province, isolation effect of phage with sewage of Guangdong province (8 times of successful isolation with 6 strains of phages) was better than that with sewage of Chongqing (7 times of unsuccessful isolation with no phage). These differences were statistically significant (P<0.05 or P<0.01). There was no obvious difference in isolation effect of phage between strains from Chongqing with sewage of Chongqing and strains from Guangdong province with sewage of Guangdong province (P>0.05). (3) The ratios of phages of ST75 and ST977 extensively drug-resistant Acinetobacter Baumannii strains lysing the strains with the same type were respectively 13/16 and 8/9, which were obviously higher than those lysing the strains with different type (respectively 11/115 and 3/53, with χ(2) values respectively 48.23 and 68.46, P values below 0.001). (4) Compared with that before storage, titer of phage under storage condition of -20 ℃, 4 ℃, and room temperature for 1 month decreased by approximately 1 order of magnitude, and that for 2 months decreased by approximately 2 orders of magnitude. After being stored for 1 month and 2 months, there were no statistically significant differences in titer of phage among 3 storage conditions (with F values respectively 1.29 and 1.07, P values above 0.05).

CONCLUSIONS

This study has successfully built an inventory covering 229 strains of phages of extensively drug-resistant Acinetobacter Baumannii. MLST of extensively drug-resistant Acinetobacter baumannii varies in different area and different time. Phage can be well isolated using sewage with the same source as that of strain. The lysis ability of phage is closely related to the MLST of strains. Inventory of phages should be built according to regional division. Moreover, phage cultured with LB fluid medium shows good stability without special requirements for storage conditions.

[Chronic neutrophilic leukemia complicated with multiple myeloma: two cases report and literature review]

OBJECTIVE

To explored the diagnosis and treatment of chronic neutrophilic leukemia (CNL) complicated with multiple myeloma (MM).

METHODS

The clinical features and molecular biological characteristics of 2 patients with CNL complicated with MM were summarized, and the diagnosis and treatment of the patients were retrospectively reviewed.

RESULTS

The diagnosis of CNL complicated with MM was established in 2 cases. Case 1 had CSF3R mutation (P733T), but CSF3R-exon 14 mutation and SETBP1 mutation were all negative. The neutrophil count returned to normal when MM was successfully treated in case 1. When the patient relapsed, neutrophil count increased again.

CONCLUSION

Coexistence of CNL and MM is rare. CSF3R is a very important molecular marker for CNL. To the best of our knowledge, it's the first time to report the coexistence of CNL and MM carried CSF3R mutation (P733T). Chemotherapy regimens for MM may be effective in the treatment of CNL complicated with MM.

Correlation between visit-to-visit and short-term blood pressure variability calculated using different methods and glomerular filtration rate

The aim of this study was to explore the correlation between visit-to-visit and short-term blood pressure variability (BPV), including systolic BPV (SBPV) and diastolic BPV (DBPV), calculated using different methods, and the glomerular filtration rate (GFR) in a late, middle-aged population. Using cluster sampling, we randomly selected retired employees of the Kailuan Group who were ⩾60 years and participated in a third health examination for 24-h ambulatory blood pressure monitoring and inspection. Among the 3064 randomly selected observation subjects, 2464 were included based on the criteria. BPV was calculated using s.d., coefficient of variation (CV, s.d./Mean), variability independent of mean (VIM, s.d./Mean^x) and BPV ratio (BPVR, s.d. (SBPV)/s.d. (DBPV)). Multivariate linear regression was used to analyse the correlation between estimated GFR (eGFR) and BPV calculated using different methods. The mean age of 2464 subjects was 67.4±6.1 years, with 1667 male subjects (67.7%). A total of 2104 cases were included in the visit-to-visit BPV group, and 1382 in the short-term BPV group. SBPV calculated using different methods showed statistically significant increasing trends for the SBP versus all s.d. and short-term BPVR. There was a significant, positive correlation between the visit-to-visit and short-term BPV calculated using different methods, which were all negatively correlated with eGFR (P<0.05). Multivariate linear regression analysis showed that, with correction for possible confounding factors, SBPV (24-h s.d., CV and VIM, and daytime CV and night time CV) and all DBPV demonstrated negative linear relationships with eGFR (P<0.05).

Analysis of soft-tissue complications of volar plate fixation for managing distal radius fractures and clinical effect while preserving pronator quadratus

The aim of the study was to analysis soft-tissue complications of volar plate fixation and it's prevention strategies along with exploring clinical effects of preserving pronator quadratus (PQ) muscle. From February 2011 to February 2013, sixty-five patients with distal radius fracture underwent open reduction and internal fixation with the volar locking palmar plates. The group with preserving PQ involved 30 patients and group with PQ repair involved 35 patients. Surgeons must took great care of not -letting drill pierce dorsal cortical bone rapidly and dorsal carpal tangential fluoroscopy was also taken in addition to lateral fluoroscopy to get accurate screw length. Volar plate must be placed not go beyond the watershed region of distal radius. The wrist pain, forearm range of motion, grip strength, wrist functional recovery score, X-ray and CT imaging were followed-up after surgery. Two groups were compared for Clinical efficacy. The minimum follow-up for the whole cohort was one year. The relevant post operative data were collected after 2 weeks, 6 weeks, 3 and 12 month respectively. Fractures healing after postoperative 3 months are significant in X -ray and CT imaging. Fixation position and stability were good, but each group had one case with a screw piercing the dorsal cortical. The -differences between the two groups were significant regarding the wrist pain, forearm range of motion, grip and strength at 2 and 6 weeks after operation, but not significant at 3 and 12 month after operation. The differences between the two groups were also significant regarding wrist functional scores at 6 weeks, but not significant at 3 and 12 month after operation. Drilling the dorsal cortical bone gently and accurate screws length can avoid extensor tendon injury. -Dorsal carpal tangential fluoroscopy is a useful supplement for accurate screws length besides lateral fluoroscopy. Volar plate's position not go beyond the watershed region of distal radius is the key factor in reducing the flexor tendon injury and preservation of the PQ muscle can also prevent the flexor tendon -injury, yield better early wrist function and shorten rehabilitation time.

[Expenditure in outpatient department and pharmacy on patients with hypertension and the influence from community health management program]

OBJECTIVE

To explore the impact of health management programs on hypertension related to their cost of the hypertensive, so as to provide evidence for related policy-making.

METHODS

Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps. Information regarding hypertensive patients were collected through a questionnaire. Two-part model was used to analyze the influence from health management scheme.

RESULTS

This study included 11 294 participants who were 35 years old or beyond, with 4 904 (43.42%) males and 6 390 (56.58%) females. The median cost from the outpatient was 100 (30-200) Yuan, and the cost of patients under management program were significantly lower than those without (P<0.05). Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P>0.05). Regarding the calculation on the outpatient cost, results showed that the patients under the management program were more likely to practice 'outpatient-medical-behavior' (OR =2.50, 95% CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients. Hypertensive patients from the urban areas were more likely to adopt 'medical behavior'(OR=1.31, 95% CI:1.18-1.45) which was 1.69 times of the costs from the rural patients. RESULTS of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10, 95% CI:1.01-1.20) and was 1.19 times the costs of the rural patients.

CONCLUSION

Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.