BACKGROUND: Insulin resistance and impaired insulin secretion are the key complications of polycystic ovary syndrome (PCOS). The incidences of insulin resistance syndrome (IRS), impaired glucose tolerance (IGT) and diabetes mellitus have been clearly shown to be race-related, thus the association between polycystic ovary syndrome and insulin resistance was race-related.OBJECTIVE: To analyze the correlation of insulin resistance with body mass index (BMI), blood lipids and plasma glucose in Tibetan patients with PCOS.DESIGN: A prospective study based on Tibetan population.SETTING: Department of Cardiology, General Hospital of Chinese PLA; Second Department of Internal Medicine,General Hospital of Tibetan Military Area Command of Chinese PLA.PARTICIPANTS: Thirty-six Tibetan PCOS patients, aged 25-42 years with a mean age of (32±5) years were selected from the Second Department of Internal Medicine and Department of Gynecology, General Hospital of Tibetan Military Area Command of Chinese PLA. Another 36 female inpatients were selected as the controls (control group), aged 24-35 years with a mean age of (30±5) years.METHODS: The disease histories were collected and general conditions were recorded. Oral glucose tolerance test (OGTT, 75 g) was conducted for all the subjects. All the subjects werefasted for 12 hours to collect venous blood samples to detect the levels of hormone, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Ovary was detected with echocardiography. The insulin resistance index was calculated by the homeostasis model assessment (HOMA-IR) was calculated by the formula:fasting insulin (mlU/L)×FPG (mmol/L)/22.5. The blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were compared between the PCOS group and control group.MAIN OUTCOME MEASURES: Blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were observed in both groups.RESULTS: All the 36 PCOS patients and 36 controls were involved in the analysis of final results. ① The BMI, systolic blood pressure and diastolic blood pressure in the PCOS group were higher than those in the control group (t =3.426 5,2.448 4, 2.212 5, P ＜ 0.05-0.01). ② The levels of total cholesterol, triglyceride and LDL-C in the PCOS group were higher than those in the control group (t=2.104 9, t =2.304 7, 2.400 0, P＜ 0.05-0.01), whereas the level of HDL-C was lower that in the control group (t =4.800 0, P＜ 0.01). ③ The levels of fasting insulin and 2-hour plasma glucose and HOM in the PCOS group were higher than those in the control group (t =7.809 5, 12.365 0, 2.789 9, P＜ 0.01).CONCLUSION: Tibetan PCOS patients present a clustering of atherosclerotic risk factors, including obesity, adverse lipid profile, hypertension, hyperglycemia, etc.

Objective]To assess the effects and mechanism of triptolide(TPL)on cardiac remodeling in chronic heart failure (CHF)rats.[Methods]Thirty-two Wistar rats were divided into four groups of eight:Control group,isoprenaline(Iso)group,TPL group(Iso+TPL)and captopril group(Iso+Cap). CHF rat model was induced by Iso. In TPL and Cap group,TPL(20μg/kg·d)and Cap(15 mg/kg·d)were administrated to CHF rats for six weeks. Left ventricular internal diameter at end-diastole(LVIDd)and left ventricular internal diameter at end-systole (LVIDs)were detected. Histopathological changes of myocardial tissues of rats were evaluated byMasson staining and immunohistochemical staining of type Ⅰcollagen. Ventricular weight/body weight ratio(VW/BW), collagen volume fraction(CVF),perivascular collagen volume area(PVCA)of myocardial tissues were calculated. With real-time polymerase chain reaction and Western blot,the protein and mRNA levels of phosphatase and tensin homologue deleted on chromosome ten(PTEN)were detected.[Results]Compared to the Iso group,the levels of LVIDs,LVIDd,VW/BW,CVF and PVCA reduced in TPL and Cap group. TPL and Cap can alleviate the myocardial fibrosis in CHF rats. The expression of PTEN protein and mRNA increased markedly in the TPL or Cap treated group.[Conclusion]TPL can attenuate cardiac remodeling in Iso-induced CHF rats. The potential mechanism may be highly associated with the up-regulating of PTEN signaling pathway.

Objective To evaluate pericardial devascularization with splenectomy (PCDV) for the treatment of cirrhotic portal hypertension. Methods From January 1994 to December 2004, 177 patients were treated by PCDS, among them posthepatitic cirrhosis was identified in 170 cases, and alcoholic cirrhosis in 7. One hundred and thirty two patients were operated on electively, 25 prophylactically, and 20 emergently. Results The bleeding control rate was 95% , the overall operative mortality rate was 4. 5%. The main causes of death were upper gastrointestinal bleeding, hepatic failure and intra-abdomimal hemorrhage. The mean follow-up time was 3. 6 years. The 5-year survival rate was 90%. The 5-year recurrent bleeding rate was 5. 1% , The rate of postoperative hepatic encephalopathy was 5. 1%. Conclusions This procedure has the advantage of high successful rate of bleeding control, low complication rate, and long term survival.

Objective To explore the indications,surgical techniques and clinical effects of laparoscopic splenectomy on patients with portal hypertension. Methods Analysis the clinical data of 32 patients of portal hypertenision with laparoscopic splenectomy and open splenectomy from March 2006 until June 2009. Results The effectiveness of the procedures for portal hypertension was evaluated.Among 16 patients with LS, 2 patients were converted to open surgery. There is no significant difference with operatative time, blood loss and hospital fees between the two groups, the laparoscpy group had the shorter mean hospitalization, fasting and draining time. Conclusions If there are enough preparation preoperation, skillful laparoscopic technique and micromesh manipulation during operation,laparoscopic splenectomy is a minimally invasive and safe technique in the patients with lower-grade to medium varicose veins.

Objective To evaluate the safety and feasibility of total laparoscopic hepatectomy for liver neoplasms.Methods Laparoscopic hepatectomy in 15 patients with liver neoplasms were completed by combined application of ultrasound scalpel,Ligasure and vascular clip without blockage of liver blood flow,including 9 cases of hepatic cavernous hemangioma,whose diameters were from 5.0 cm to 15.0 cm,3 cases of hepatic cyst with fibrosis,located in left lateral hepatic lobe,3 cases of primary hepatic carcinoma,whose diameters were from 1.0 cm to 5.0 cm and the hepatic functions were all Child A.Results Laparoscopic hepatectomy was completed successfully in all 15 cases with no conversion to open laparotomy,including 6 cases of left lateral hepatectomy,9 cases of irregular hepatectomy.The mean operative time was 110 min,blood loss during operation was from 30 ml to 500 ml,the average was 251 ml.The mean postoperative hospital stay was 6.5 d.The mortality rate was 0%.No severe complications occurred except 1 case of small amount bleeding which stopped itself.Conclusion Total laparoscopic hepatectomy is a feasible,safe and minimal invasive approach for patients with liver neoplasms within segment Ⅱ、Ⅲ、Ⅳa、Ⅴ、 and Ⅵ.

Objective:To investigate the value of immune inflammatory index in predic-ting the therapeutic efficacy of neoadjuvant chemoradiotherapy for esophageal squamous cell carci-noma (ESCC).Methods:The retrospective case-control study was conducted. The clinicopatholo-gical data of 163 patients with ESCC who were admitted to Zhongshan Hospital of Fudan University from December 2015 to December 2020 were collected. There were 135 males and 28 females, aged (62±8)years. All 163 patients underwent neoadjuvant chemoradiotherapy and radical resection for ESCC. Observation indicators: (1) relationship between immune inflammatory index and clinical characteristic in patients; (2) relationship between immune inflammatory index and efficacy of neoadjuvant chemoradiotherapy in patients; (3) influencing factor analysis for pathologic complete response and good response of tumor regression grade after neoadjuvant chemoradiotherapy; (4) efficiency of immune inflammatory index in predicting efficacy of neoadjuvant chemoradiotherapy. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was conducted using chi-square test. Comparison of ordinal data was conducted using the rank sum test. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value. Univariate and multi-variate analyses were conducted using the Logistic regression model. The area under the curve (AUC) of ROC curve was used to evaluate the efficiency of predictive model. Results:(1) Relationship between immune inflammatory index and clinical characteristic in patients. ① Optimal cut-off value of systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lympho-cyte ratio (PLR). Results of ROC curve analysis showed that the AUC of SII, NLR, PLR in predicting efficacy of neoadjuvant chemoradiotherapy for patients with ESCC was 0.70(95% confidence interval as 0.61?0.77), 0.78(95% confidence interval as 0.69?0.84), 0.79(95% confidence interval as 0.70?0.85), respectively, with the maximum value of Youden index and the optimal cut-off value as 0.25, 0.32, 0.52 and 446×10 9/L, 2.09, 138. ② Relationship between SII, NLR, PLR and clinical charac-teristic in patients. According to the optimal cut-off value of SII, NLR, PLR, all 163 patients were divided into cases with SII <446×10 9/L as 99, cases with SII ≥446×10 9/L as 64, cases with NLR <2.09 as 107, cases with NLR ≥2.09 as 56, cases with PLR<138 as 88, cases with PLR ≥138 as 75, respectively. There was a significant difference in clinical N staging of tumor in patients with SII <446×10 9/L and SII ≥446×10 9/L ( P<0.05). There were significant differences in clinical N staging and clinical TNM staging of tumor in patients with NLR<2.09 and NLR≥2.09 ( P<0.05). (2) Relationship between immune inflammatory index and efficacy of neoadjuvant chemoradiotherapy in patients. Of 163 patients undergoing neoadjuvant chemoradiotherapy, there were 54 cases with pathologic complete response and 109 cases without pathologic complete response, 94 cases with good response of tumor regression grade and 69 cases with poor response of tumor regression grade. Of the 54 patients with pathologic complete response, cases with SII <446×10 9/L and SII ≥446×10 9/L, cases with NLR <2.09 and NLR ≥2.09, cases with PLR <138 and PLR ≥138 before neoadjuvant chemoradiotherapy were 42 and 12, 47 and 7, 48 and 6, respectively. The above indicators were 57 and 52, 60 and 49, 40 and 69 in the 109 cases without pathologic complete response. There were significant differences in the above indicators between patients with pathologic complete response and without pathologic complete response ( χ2=9.83, 16.39, 39.60, P<0.05). Of the 94 cases with good response of tumor regression grade, cases with SII <446×10 9/L and SII ≥446×10 9/L, cases with NLR <2.09 and NLR ≥2.09, cases with PLR <138 and PLR ≥138 before neoadjuvant chemoradiotherapy were 59 and 35, 78 and 16, 56 and 38, respectively. The above indicators were 40 and 29, 29 and 40, 32 and 37 in the 69 cases with poor response of tumor regression grade. There was no significant difference in the SII and PLR ( χ2=0.38, 2.79, P>0.05) and there was a significant difference in the NLR ( χ2=29.59, P<0.05) between patients with good response of tumor regression grade and poor response of tumor regre-ssion grade. (3) Influencing factor analysis for pathologic complete response and good response of tumor regression grade after neoadjuvant chemoradiotherapy. Results of multivariate analysis showed that PLR <138 before neoadjuvant chemoradiotherapy was an independent protective factor for pathologic complete response in ESCC patients undergoing neoadjuvant chemoradiotherapy ( odds ratio=1.98, 95% confidence interval as 1.56?2.51, P<0.05) and NLR <2.09 before neoadjuvant chemo-radiotherapy was an independent protective factor for good response of tumor regression grade ( odds ratio=2.50, 95% confidence interval as 1.40?4.46, P<0.05). (4) Efficiency of immune inflam-matory index in predicting efficacy of neoadjuvant chemoradio-therapy. The AUC of PLR <138 before neoadjuvant chemoradiotherapy in predicting pathologic complete response of ESCC patients undergoing neoadjuvant chemoradiotherapy was 0.79(95% confidence interval as 0.64?0.87, P<0.05), with the sensitivity, specificity and Youden index as 0.89, 0.63 and 0.52, respectively. The AUC of NLR <2.09 before neoadjuvant chemoradiotherapy in predic-ting good response of tumor regression grade of ESCC patients undergoing neoadjuvant chemoradio-therapy was 0.76 (95% confidence interval as 0.64?0.81, P<0.05), with the sensitivity, specificity and Youden index as 0.83, 0.58 and 0.41, respectively. Conclusion:The PLR<138 and NLR <2.09 before neoadjuvant chemoradiotherapy are independent protective factors for the pathologic complete response and good response of tumor regression grade, respectively, of ESCC patients undergoing neoadjuvant chemoradiotherapy, and both of them can predict the curative effect of neoadjuvant chemoradiotherapy well.

Purpose To evaluate the diagnostic accuracy of abdominal plain scan and contrast-enhanced multi-slice CT after orally diluted iodide in time segment(Post-ODI ANCCE-MSCT)for gastrointestinal fistula(GIF)secondary to acute pancreatitis(AP).Materials and Methods A total of 108 patients with late AP in the prospective and continuously collected database of Hunan Provincial People's Hospital from January 2017 to December 2022 were retrospectively extracted.Their demographic information and clinical features were recorded and GIF were screened by Post-ODI ANCCE-MSCT.The comprehensive clinical diagnosis results within 5 days thereafter were used as reference standards.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Post-ODI ANCCE-MSCT for diagnosing GIF secondary to AP were calculated using a four-cell table,and the consistency of the two methods was evaluated by Kappa test and McNemar's test.Results Sensitivity was 91.5%(95%CI 78.7%-97.2%),specificity was 98.4%(95%CI 90.0%-99.9%),positive predictive value was 97.7%(95%CI 86.5%-99.9%),negative predictive value was 93.8%(95%CI 84.0%-98.0%),and the accuracy was 95.4%(95%CI 91.4%-99.3%),respectively.The Kappa value was 0.905,and P value was 0.375 via McNemar's test.Conclusion Post-ODI ANCCE-MSCT can diagnose GIF secondary to AP in a simple,non-invasive,rapid and accurate way,and provide earlier,more accurate and reliable image basis for clinical diagnosis and treatment.

Ambystoma mexicanum/immunology* ; Amputation ; Animals ; Biomarkers/metabolism* ; Blastomeres/immunology* ; Cell Lineage/immunology* ; Connective Tissue Cells/immunology* ; Epithelial Cells/immunology* ; Forelimb ; Gene Expression ; High-Throughput Nucleotide Sequencing ; Humans ; Immunity ; Peroxiredoxins/immunology* ; Regeneration/immunology* ; Regenerative Medicine/methods* ; Single-Cell Analysis/methods*