The operation signature regulation in force in China means giving the right of signature agreeing to the operation to a third party including the patients family. This kind of practice not only goes against the principle of informed consent and relevant regulations as stipulated in the General Rules of the Civil Law of the Peoples Republic of China and the Contract Law of the Peoples Republic of China, but is also likely to cause medical disputes. For this reason, the signatory right agreeing to the operation ought to belong to the patient himself unless it is a legal matter.

Objective To analyze the clinical data of laparoscopic total hysterectomy after cervical cold knife conization (CKC) in patients with cervical intraepithelial neoplasia (CIN), and study the supplemental treatment methods after cervical cold knife conization in patients with CIN Ⅲ. Methods The clinical data of 101 patients with CIN Ⅲ were retrospectively analyzed, the patients were treatment with laparoscopic total hysterectomy after cervical cold knife conization. Results Among the 101 patients, the accordant pathological result of cervical biopsy under colposcopy and cervical cold knife conization was in 68 cases (67.3%), while 6 cases (5.9%) pathological upgraded to invasive carcinoma. The positive margins after cervical cold knife conization was in 23 cases, and negative margins was in 78 cases. Among the positive margins patients, 11 cases had residual lesion, including 2 cases of CINⅠ, 2 cases of CINⅡ, 5 cases of CIN Ⅲ, 2 cases of microinvasive carcinoma. The rate of residual lesions was 47.8%(11/23). Among the negative margins patients, 7 cases had residual lesion, including 4 cases of CINⅠ, 2 cases of CIN Ⅱ, 1 case of CIN Ⅲ. The rate of residual lesions was 9.0% (7/78). There was statistical difference in the rate of residual lesions between 2 groups (P<0.05). Conclusions The cervical biopsy under colposcopy has high risk of missing diagnosis of cervical cancer, thus it can not replace the diagnosis of cervical cold knife conization. There is still a certain percentage of residual lesions in the negative margins of cervical cold knife conization. The patients with recurrence or residual risk factors may be considered further surgical treatment.

Objective To observe the changes in gut mucosal barrier and gut-origin bacteria-endotoxin translocation in acute necrotizing pancreatitis (ANP) rats. Methods Wistar rats were divided randomly into normal group (n=6), sham operation group (n=30) and ANP group (n=39). ANP was introduced by infusion of artificial bile into biliopancreatic duct. Morphology of pancreas and intestine were observed and tight junction on ileum epithelia were assessed by cryofracture replicas electroscopy. Plasma levels of D-lactic acid and endotoxin were examined at various time points. The rates of bacterial translocation to abdominal organs were also calculated. Results Mucosal and tight junction damages of the gut were found during early stage of ANP. Simultaneously, plasma D-lactate levels increased and endotoxemia occurred. The rate of bacterial translocation to organs was 59.5% 72h after ANP occurred. Conclusions Gut barrier function can be injured in the early stage of ANP, and resulting in gut origin bacteria-endotoxin translocation, which may be the originator of systemic inflammatory reaction and secondary infection of the pancreas.

Objective To investigate the influence of chronic fluorosis on protein kinase Cβ (PKCβ)/p66shc signal pathway in the brain of rats,and reveal the molecular mechanism of brain damage.Methods According to body weight by the random number table method thirty SD rats were divided into three groups of 10 each (half females and half males),the normal control group [less than 0.5 mg/L of fluorine (prepared with NaF) in drinking water],low fluoride exposure group (10.0 mg/L fluorine),and high fluoride exposure group (50.0 mg/L fluoride).The experiment period was 6 months.The protein level of PKCβ,p66shc,phospho-p66shc and preserved ammonia acyl isomerase (Pin1) in rat brain was detected by Western blotting.The level of neuron nuclear antigen (NeuN),p66shc and phospho-p66sh in brain of rats was detected by immunohistochemistry.Results By Western blotting,the levels of PKCβ,Pin1 and phospho-p66shc protein in brain tissue in high fluoride exposure group [(193.00 ± 57.53)％,(228.21 ± 71.14)％,(201.54 ±:50.86)％] were higher than those of the normal control groups [(100.00 ± 21.24)％,(100.00 ± 40.55)％,(100.00 ± 13.35)％,all P ＜ 0.05].By immunohistochemistry,the numbers of NeuN staining in brain tissue of the rats in both high and low fluoride exposure groups [(49.50 ± 12.57)％,(65.66 ±14.58)％] were lower than that of the control group [(100.00 ± 18.32)％,all P ＜ 0.01].The level of phospho-p66shc protein in brain tissue in high fluoride exposure group [(242.66 ± 93.01)％] was higher than those of the low fluoride exposure and the normal control groups [(152.53 ± 60.65)％,(100.00 ± 25.63)％,all P ＜ 0.01].Conclusion Chronic fluorosis has increased the expressions of PKCβ,Pin1 and phospho-p66shc at protein level in brain of rats,which may be related to the molecular mechanism of brain damage resulted from chronic fluorosis.

Objective To evaluate the prevalence of subclinical atherosclerosis in rheumatoid arthritis (RA) and the related risk factors.Methods Fifty RA patients without overt atherosclerotic disease and 121 control subjects matched for age and sex were recruited.Duplex carotid sonography was used to measure intima-media thickness (IMT) and plaque formation assessment.Differences between RA and the control group were compared, and the risk factors were explored.RA patients then were divided into two subgroups according to IMT and the comparison between the two subgroups were completed.T test, Mann-Whitney U test, chi-square test, Pearson's correlation and Logistic regression analysis were used for statistical analysis.Results Although RA patients had lower level of serum lipids and body mass index than the control group, the mean IMT value was significantly higher in the RA group than that in the control group [(0.78±0.18) mm vs (0.62±0.14) mm, t=5.853, P=0.000], and plaque formation was more prevalent [56.0％(28/50) vs 36.4％ (44/121),x2=5.596, P=0.018].The difference was especially significant in the younger groups (＜50 years old group and 50-60 years old group).Logistic regression showed that the presence of RA [OR=7.34, 95％CI (2.53, 21.25)], male [OR=2.0, 95％CI (91.25, 3.17)] and old age [OR=1.1, 95％CI (1.04, 21.15)] were the independent risk factors for abnormal IMT (thickened or the presence of carotid plaques).The RA patients were divided into two subgroups according to IMT.Compared with patients with normal IMT, patients with abnormal IMT were older and more common in postmenopausal, and had longer RA duration and higher cholesterol level.In treatment, less patients with abnormal IMT had been taking methotrexate (MTX) for more than 3 months compared with patients with normal IMT.Among these parameters, old age [OR=1.13, 95％CI (1.03, 1.23)] was shown to be the independent risk factor for abnormal IMT in RA patients, and more than 3 months of MTX treatment [OR=0.12, 95％CI (0.02, 0.71)] was the protective factor.Conclusion Atherosclerosis occurs frequently and prematurely in patients with RA and the presence of RA is an independent risk factor for atherosclerosis.Early primary prevention for atherosclerosis should be recommended.MTX probably has a positive effect on preventing atherosclerosis for RA patients, which needs to be confirmed by further study.

Objective:To verify the fracture risk assessment tool ( FRAX) to estimate the probability of osteoporotic fracture in patients with rheumatoid arthritis ( RA ) with or without bone mineral density (BMD), and identify associated risk factors of osteoporosis .Methods: In the study, 200 patients with rheumatoid arthritis aged more than 40 years in Peking University First Hospital from Dec .2009 to Dec. 2012 were recruited.Clinical information was obtained from a questionnaire of their case history and medical records.FRAX tool was administered.Their lumber spine and left femoral BMD were determined by dual energy X ray absorptiometry.The gender, age, disease duration, menopause status, body mass index ( BMI) and accumulative dose of glucocorticoid were obtained in retrospect .Correlation analysis was conducted between the BMD and clinical information .Results:The study population ( female, 77.5%) had a mean age of 59.4 years, in which 10 (13%) patients showed a normal BMD, 67 (87%) were osteopenia or osteoporosis , while 32 patients (16%) had fragile fracture.Compared with the patients with normal BMD, the subjects with low BMD had significantly older age , longer period for corticoids usage , higher day dose and accumulated dose of corticoids .The 10-year fracture risk of sustai-ning major osteoporotic fractures and hip fracture was higher .No significant difference was observed be-tween the 10-year fracture risks calculated with BMD and without BMD .The values of the different area under the receiver operating characteristic ( ROC) curve ( AUC) for major and hip fractures calculated in three ways:without BMD, with the femoral neck BMD, and with T-score.The best result was for FRAX tool for hip fracture with the T-score ( AUC 0 .899 ) .A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low BMD . Three statistically significant variables for lumber BMD were pain on visual assessment scale ( VAS ) (P=0.02), fracture history (P=0.003) and a higher steroid accumulated dose (P=0.008).Three statistically significant variables for left hip BMD were age (P<0.001), fracture history (P=0.05) and lower BMI ( P=0.03) .Conclusion:Low BMD is a common complication in RA patients .Risk factors for major fracture and hip fracture are increased .There is a positive correlation between FRAX calculated with and without BMD or T score .FRAX with the femoral neck T score or BMD presents a discriminatory capacity better than FRAX without BMD , according to the AUC ROC .

Objective To investigate the outcomes of patients with rheumatoid arthritis (RA) treated by different combination of synthetic disease modifying antirheumatic drugs (DMARDs) under the guidance of treat-to-target strategy.Methods Forty-two RA patients with high disease activity were enrolled into this randomized,open-label and prospective study.It was comprised of a maximal 36-week induction phase and then followed by a maintenance phase up to 84 weeks.Combination of synthetic DMARDs was initiated in the induction phase,with or without low dose glucocorticoids (GCs) during the first 12 weeks.Patients who achieved low disease activity (LDA) were randomized into two maintenance groups.An increase of DAS28 by 0.6 was defined as relapse.The patients achieved LDA in the induction phase,relapsed during maintenance phase and possible relevant risk factors were analyzed.Results Twenty-seven (64％) patients achieved LDA during the induction phase.More non-smoking patients achieved LDA than those smoked [85％ (11/13) vs 55％(16/29),P＜0.05].During the maintenance phase,14 (61％) out of 27 patients relapsed.Patients taking GCs during the first 12 weeks had a significantly higher relapse rate compared to those without GC (83％ vs 36％,P=0.021).Patients who entered maintenance phase at week 12 had a significantly higher tendency to relapse compared to those who entered the maintenance phase at week 24 [75％(9/12) vs 33％(3/9),P=0.026].Conclusion Smoking seems to be a risk factor for RA patients who fail to reach LDA.Low dose GCs as a bridge therapy may require a longer duration.High relapse rates in both the maintenance groups indicat that a longer tight induction phase may be appropriate before downstairs therapy.

Objective To study the clinical use of microwave scalpel in hepatectomy for hepatocellular carcinoma without hepatic vascular inflow occlusion.Methods A retrospective study was conducted on the clinical data of 126 consecutive patients with hepatocellular carcinoma who were treated at the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to August 2018.The patients included 111 males and 15 females,with ages which ranged from 25 to 75 years.These patients were divided into two groups by the different surgical resection methods:the microwave scalpel hepatectomy (MSH) group which employed microwave scalpels to perform hepatectomy (n =42),and the ultrasound scalpel hepatectomy (USH) group which employed ultrasound scalpels (n =84).The perioperative conditions which included baseline data,amount of intraoperative bleeding,liver function after operation,and morbidity of postoperative complications were compared.Results There were no significant differences in the preoperative indexes which included tumor diameter,number of tumors,levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) between the 2 groups (all P ＞ 0.05).In the MSH group,the amount of intraoperative bleeding was 100.0 (100.0,200.0) ml,which was significantly lower than the 300.0 (100.0,400.0) ml in the USH group (P ＜ 0.05).Compared with the USH group,the levels of AST and ALT on postoperative day 1,3,7 after operation in the MSH group were significantly lower (all P ＜ 0.05),and the corresponding albumin levels were significantly higher than the USH group (P ＜0.05).The incidence of complications was 4.8％ (2/42) in the MSH group which was significantly lower than that of 20.2％ (17/84) in the USH group (P ＜ 0.05).Conclusion Microwave scalpel significantly reduced intraoperative bleeding and postoperative complications,and led to less liver functional injury.

OBJECTIVE: To explore the genetic basis for an individual with a para-Bombay phenotype. METHODS: A proband with mismatched forward and reverse serotypes for the ABO blood group was identified. Weakly expressed ABH blood type antigen on the surface of red blood cells was verified by absorption and release test, and the blood group substances in saliva was detected by sialic acid test. Exons 6 and 7 of the ABO gene and exons of the FUT1 and FUT2 genes were subjected to direct sequencing. RESULTS: The proband was found to be of O type by forward ABO serotyping and AB type by reverse ABO serotyping, though H and substance A and B were detected in her saliva. DNA sequencing revealed that she has harbored c.35C/T, c.328G/A, and c.504delC compound heterozygous variants of the FUT1 gene. Haploid analysis showed that her FUT1 genotype was h328A/h35T+504delC, which has been uploaded to the NCBI website (No. MW323551). CONCLUSION The para-Bombay phenotype of the proband may be attributed to the novel compound heterozygous variants including c.504delC of the FUT1 gene, which may affect its function by altering the activity of FUT1 glycotransferase.
ABO Blood-Group System/genetics* ; Alleles ; China ; Female ; Fucosyltransferases/genetics* ; Genotype ; Humans ; Phenotype

Objective To investigate the effect of nuclear-transcription factor-κB signal transduction pathway on differentiation of rat marrow mesenchymal stem cells (MSCs) into neurons.Methods The MSCs were purified at least four generations in vitro.And then,the MSCs were assigned into three groups:non-serum control group (group A),fasudil treatment group (group B) and fasudil and lipopolysaccharide treatment group (group C).Cells in group A were added serum-free DMEM,those in group B were added induced liquid (DMEM 900 μL+fetal bovine serum 100 μL that contains final concentration of 200 μmol/L of fasudil),and those in group C were added induced liquid (DMEM 900 μL+fetal bovine serum 100 μL that contains final concentration of 200 μmol/1 of fasudil and final concentration of 1000 μg/L of lipopolysaccharide).All the MSCs were induced into neurons for 6 h.The morphology of MSCs was observed under inverted fluorescence microscope.The expressions of neuronspecific enolase (NSE),microtubule-associated protein (MAP)-2,cyclin D1 and glial fibrillary acidic protein (GFAP) in neurons were detected by immunocytochemical method.The mRNA expressions ofcyclin D1 and MA P-2 in neurons were detected by real time-PCR.The protein expressions ofcyclin D1 and MAP-2 were detected by Western blotting.Results (1) The MSCs of group A kept flat and the neurites were scarce;the MSCs of group B and C could differentiate into neurons,and the speed of MSCs of group B differentiating into neurons was faster than that in group C;there was typical neural network in group B and the neural network in group C was scarcer than group B.(2) As compared with those in group A,higher expression levels of NSE and MAP-2,and lower cyclin D1 expression level in group B and group C were noted (P＜0.05);the expression percentage of GFAP was lower than 1％ in both three groups.(3) As compared with group A,group B and group C had significantly lower cyclin D1 protein and mRNA expressions and significantly higher MAP-2 protein and mRNA expressions (P＜0.05).Conclusion The NF-κB signal transduction pathway,by regulating the expression of cyclin D1,participates in the neuronal differentiation of rat marrow mesenchymal stem cells induced by fasudil.