ObjectiveTo investigate the changes of renin-angiotensin-aldosterone system (RAAS) and glomerular filtration rate (GFR) in epidurally-anesthetized patients undergoing gynecological laparoscopy with 15° head-down position and low insufflation pressure. MethodsTwenty gynecological patients(ASA grade I- Ⅱ )were studied during CO2 insufflation with an intra-abdominal pressure of 1012mmHg and 15° head-down position. Arterial blood samples were obtained for the measurements of serum concentrations of plasma renin activity(PRA), angiotensin Ⅱ (All), aldosterone(ALD) and β2-microglobulin(β2-MG)by radioimmunoassay at the following five time points: before insufflation, at 10min, 30min and 60 min after insufflation respectively and after desufflation. Arterial blood gas analysis was made in 10 of the cases simultaneously. ResultsCompared with preinsufflation, there was no significant decrease in the plasma levels of PRA, All ,ALD and β2-MG during CO2 pneumoperitoneum except for PRA at 10 min after insufflation(P ＜0.05). As the time of insufflation went on, the measurements above showed a tendency of slightly increase. The PaCO2 during peritoneal CO2 insufflation was increeseing ( P ＞ 0.05) and reached its maximum at 30 min after insufflation. The pH values of 30～60 min after insufflation were significantly decreased as compared with that of before insufflation. ConclusionThe epidural anesthesia may inhibit the response of RAAS to (CO2 insufflation pressure of 10-12mmHg and has no effect on GFR during gynecological laParoscopy.

Objective To explore the feasibility of laparoscopic operations in the treatment of ovarian benign tumors. Methods A retrospective analysis of 150 cases of ovarian benign tumors treated by laparoscopic surgery (146 cases of oophorocystectomy and 4 cases of adnexectomy) from January 1997 to October 2003 was made. Results Surgery was completed successfully in all the 150 cases and no conversions to open surgery were required. Mild extraperitoneal emphysema was observed in 2 cases and no other complications occurred. The mean blood loss was 100 ml, the mean operation time was 80 min, and the mean length of hospitalization was 4 3 days. A total of 128 cases were followed up for a mean of 3 8 years. Recurrence was found in 4 cases in 38 cases of endometriosis cysts. Among 15 patients complicated with infertility, conception occurred in 6 patients after surgery, with a pregnancy rate of 40%. Conclusions Laparoscopic surgery is safe and effective for ovarian benign tumors provided patients are properly selected.

Objective To investigate the relationship between truncating mutations of APC gene and sporadic colorectal cancer,and analyze the feasibility of non-radioactive protein truncation test (PTT) in the detection of mutations of APC gene.Methods Ninety-six samples of sporadic colorectal cancer tissues ( including 44 patients with colonic cancer and 52 patients with rectal cancer) were obtained from the General Hospital of Ningxia Medical University from September 2008 to September 2010.The mutation cluster region of the APC gene was screened using digital PTT labeled with fluorescent Lys-t-RNA,with a polymerase chain reaction fragment amplified from genomic DNA serving as a tenplate for in vitro translation.The occurrence of gene mutation was determined according to the emergence of truncated peptides.The mutation cluster region of the APC gene in 46 samples of colorectal cancer tissues was analyzed by direct sequencing.The detection rates of the 2 methods were compared by chi-square test.Results Thirteen (26％) truncated peptides were detected in the 50 samples of colorectal cancer tissues.The mutation type of 4 samples is nonsense mutation,which resulted in emergence of truncated gene products.Eleven (24％) truncated peptides were detected in the 46 samples of colorectal cancer tissues.There was no significant difference in the detection rates between PTT and direct sequencing ( x2 =0.033,P ＞ 0.05 ).Conclusions Truncating mutations of APC gene are common alterations in sporadic colorectal cancer in the Chinese.Digital PTT labeled with fluorescent Lys-t-RNA is rapid and high-sensitive in screening gene mutations.

Objective:To investigate the effect of controlled low central venous pressure (CLCVP) combined with hepatic blood occlusion on blood loss and hemodynamics in hepatectomy. Methods:Sixty hepatocellular carcinoma patients with American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ undergoing hepatectomy were randomly divided into two groups. One was the group of hepatic blood occlusion (group I);the other was the group of CLCVP combined with hepatic blood occlusion (group II). During the parenchy-mal transection phase of surgery, 60.05). Likewise, no significant difference was noted in MAP and HR at different time points of the two groups (P>0.05). The CVP in groupⅡwas significantly lower than that in groupⅠat the beginning of and 20 min after the paren-chymal transection phase of the surgery. Conclusion:CLCVP combined with hepatic blood occlusion can reduce blood loss effectively during hepatectomy.

Objective To investigate whether Bw4 motif expressed on HLA-B affects Gag-specific T cell responses in patients with acute HIV-1 infection.Methods Sequence specific primer polymerase chain reaction ( SSP-PCR) was performed for human leukocyte antigen ( HLA) typing.Peripheral blood mononuclear cells ( PBMCs) from 36 patients with six months of acute HIV-1 infection were stimulated with HIV-1 CRF01_A/E Gag peptides to detect the HIV-1 specific T cell responses by using ELISPOT assay. Results (1) The set point viral load of 18 patients carrying no Bw4 motif on HLA-B was 4.49±0.56 which was higher than that in other 18 patients carrying 1-2 Bw4 motif(s) on HLA-B (3.78±0.75) (P=0.005). (2) T cells from 26 out of 36 patients with acute HIV-1 infection responded to P24 peptides pool including 15 patients carrying no Bw4 motif on HLA-B and 11 patients carrying 1-2 Bw4 motif( s) on HLA-B, but no significant difference was observed between them (P>0.05).The magnitude of P24-specific T cell responses induced in patients carrying no Bw4 motif on HLA-B was (1317.8 ±1238.0) SFC/106 PBMCs which was greater than that induced in patients carrying 1-2 Bw4 motif(s) on HLA-B [(549.9±778.5) SFC/106 PBMCs] ( P=0.032) .The breadth of T cell responses to P24 peptides was 2(0-5) in patients carrying no Bw4 motif on HLA-B which was broader than that of patients carrying 1-2 Bw4 motif(s) on HLA-B [1(0-4)] (P=0.080).(3) The viral loads of HIV-1 infected patients carrying no Bw4 motif on HLA-B were negatively correlated with the magnitude of P24-specific T cell responses (rs=-0.482, P=0.043) and the breadth of responses to P24 peptides (rs=-0.496, P=0.036).No correlations were observed between viral loads and the magnitude or breadth of P24-specific T cell responses in HIV-1 infected patients carrying 1-2 Bw4 motif(s) on HLA-B.Conclusion Compared with HIV-1 infected patients carrying no Bw4 motif on HLA-B, the patients carrying 1-2 Bw4 motif( s) on HLA-B showed lower levels of set point viral load, weak-ened magnitude of P24-specific T cell responses and narrowed breadth of responses to P24 peptides.

Objective To compare the detection of flu A by nucleic acid amplification assav and rapid antigen assay in nasopharynx swabs and oropharynx swabs of flu-like patients.Methods A total of 170 flu-like patients were recruited in out-patient of Youan Hospital from September to October in 2009.Both nasopharynx swabs and oropharynx swabs were collected.Flu A virus was detected by both real-time reverse transcriptation polymerase chain reaction (RT-PCR) and rapid antigen assay.The data were analyzed by chi square test.Results For nasopharynx swabs,the positive rate of nucleic acid amplification assay was 74.1%(126/170),while that of rapid antigen assay was 65.9%(112/170)(X2=2.75,P>0.05).However,for oropharynx swabs,the positive rate of nucleic acid amplification assay was much higher than that of rapid antigen assay(62.9% vs 38.8%)(X2=19.78,P<0.01).Moreover,for nucleic acid amplification assay,the positive rate of nasopharynx swabs were higher than that of oropharynx swabs (X2=4. 90, P<0. 05). For rapid antigen assay, the positive rate of nasopharynx swabs was also higher than that of oropharynx swabs (X2=24.95, P<0.01). Based on the outcome of flu A detected with nasopharynx swabs by the nucleic acid amplification assay,the sensitivities of oropharynx swabs by nucleic acid amplification assay,oropharynx swabs by rapid antigen assay, nasopharynx swabs by rapid antigen assay were 81.7%,50.0% and 94.8%, respectively; the specifieities were 90.9%, 93.2% and 95.5%, respectively;the positive predictive values were 96. 3%, 95. 5% and 98.2%, respectively; the negative predictive values were 63.5 %, 39.4 % and 72.40%, respectively; Kappa coefficients were 0.64, 0.30 and 0.75,respectively; the total coincidences were 84.1%, 61.20% and 89.4%, respectively. Conclusions The detection of flu A with nasopharynx swabs is more sensitive than oropharynx swabs, and nucleic acid amplification assay is more sensitive than rapid antigen assay.

OBJECTIVETo explore the differential characteristics of the AMA-M2 autoantibody in patients with primary biliary cirrhosis (PBC) and non-PBC patients.

METHODSPatients with abnormal liver function at the Capital Medical University affiliated to Beijing You-an Hospital were enrolled in this study between January 2011 and December 2013. Serum levels of ANA, AMA and AMA-M2 were detected by indirect fluorescence assay and enzyme-linked immunosorbent assay. The patients' clinical data was obtained for retrospective analysis. Statistical analyses were performed using the SPSS 16.0 software. Enumeration data have been presented as numbers and percentages, and were analyzed using the chi-square test and one-way ANOVA test.

RESULTSOf the 5315 patients with abnormal liver function, 15.3% (811/5315) were AMA-M2 positive patients; among those 811 patients, 78.4% (636) had PBC, 4.4% (36) had PBC overlapping with autoimmune hepatitis (AIH), 4.4% (36) had drug-induced liver injury, 6.5% (53) had hepatitis B, 3.3% (27) had hepatitis C, 0.6% (5) had hepatitis E, 0.9% (7) had alcoholic liver disease, 0.5% (4) had non-alcoholic fatty liver, 0.8% (6) had primary hepatic carcinoma, and 0.1% (1) had infectious mononucleosis. Serum AMA-M2 level was significantly higher in the PBC patients (vs. other groups, P less than 0.001) with the exception of the patients with PBC/AIH overlap syndrome. Among the 811 patients with AMA-M2 positivity, 88.5% (718) showed AMA positivity and 91.1% (739) showed ANA positivity. Serum alanine transferase (ALT) and aspartate transferase (AST) levels were significantly higher in the drag-induced liver injury patients (527.74+/-684.65 U/L, 490.60+/-716.89 U/L) and the hepatitis E patients (1015.94 ± 165.55 U/L, 665.4 ± 297.14 U/L) than in the PBC patients (96.02 ± 115.56 U/L, 94.82 ± 83.32 U/L) (ALT: F =8.041, P < 0.001, P < 0.001; AST: F =8.066, P < 0.001, P < 0.001). Serum alkaline phosphatase (ALP; 265.16 ± 179.08 U/L) and glutamyl transferase (GGT; 332.02 ± 279.29 U/L) were significantly higher in the PBC patients than in the hepatitis B patients (135.35 ± 123.17 U/L, 140.27 ± 229.24 U/L) and the hepatitis C patients (85.65 ± 27.77 U/L, 92.70 ± 125.72 U/L) (ALP: F=3.911, P =0.01, P=0.001; GGT: F=4.081, P <0.001, P < 0.001). The serum IgM level was significantly higher in the PBC patients (4.60 ± 2.67 g/L) than in the patients with drug-induced liver injury (1.76 ± 1.15 g/L), hepatitis B (2.02 ± 1.41 g/L), hepatitis C (1.48 ± 0.92 g/L), hepatitis E (1.40 ± 0.68 g/L), alcoholic liver disease (1.57 ± 1.07 g/L), non-alcoholic fatty liver (1.05 ± 0.72 g/L), and primary hepatic carcinoma (2.64 ± 2.26 g/L) (F=16.83, P < 0.001, P < 0.001, Probability value < 0.001, Probability value < 0.05, Probability value < 0.01, Probability value < 0.05 respectively).

CONCLUSIONAlthough detection of serum AMA-M2 is an important feature of PBC diagnostic testing,there is a high ratio of serum AMA-M2 detected in patients with drug-induced liver injury, hepatitis B, C and E, alcoholic liver disease, non-alcoholic fatty liver,and primary hepatic carcinoma. The AMA-M2 positive non-PBC patients still require close observation to watch for future development of PBC.

Autoantibodies ; Beijing ; Carcinoma, Hepatocellular ; Chemical and Drug Induced Liver Injury ; Enzyme-Linked Immunosorbent Assay ; Hepatitis B ; Hepatitis C ; Hepatitis, Autoimmune ; Humans ; Liver Cirrhosis, Biliary ; Liver Diseases, Alcoholic ; Liver Function Tests ; Liver Neoplasms ; Retrospective Studies

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

Objective: To understand the characteristics and clinical significance of anti-soluble liver antigen antibody (anti-SLA) in patients with liver diseases. Methods: Serum samples from seventy-seven patients with anti-SLA were collected from Beijing You'An Hospital during the period between January 2010 and December 2018. Anti-SLA, anti-liver cytosol type 1 antibody (anti-LC1), anti-glycoprotein 210 antibody(anti-gp210) and anti-nuclear body protein sp100 antibody(anti-sp100) were detected by immunoblotting; indirect immunofluorescence assay used for detecting anti-nuclear antibody (ANA), anti-mitochondrial antibody (AMA), anti-smooth muscle antibody (SMA), and anti-liver kidney microsome antibody (anti-LKM). One-way analysis of variance was used to compare the ages of different anti-SLA groups. The non-parametric rank sum test was used to compare the liver function indexes and immunoglobulins in different intensity groups of anti-SLA. P<0.05 was considered statistically significant. Further comparisons were made between the two groups, the correction level α′=0.008 3, P<0.008 3 was considered statistically significant. Results: The average age of 77 anti-SLA positive patients was (52.50±1.25) years old, 70 females (90.9%) and 7 males (9.1%). 80.5% of anti-SLA-positive patients (62/77 cases) were strongly positive at the time of initial diagnosis (+++ to ++++).The Alanine aminotransferase (ALT) level in the SLA++ group was higher than that in the SLA++++ group (232.7 U/L vs 65.6 U/L,χ²=7.751,P=0.005) and the immunoglobulin M(IgM) level in the SLA+++ group was lower than that in the SLA++++ group (1 270 mg/L vs 2 270 mg/L,χ²=8.337,P=0.004).There was no significant difference in age, other liver function and immunological indicators among the different groups.Seventy cases (90.9%) were both anti-SLA and ANA positive, 13 cases (16.9%) were positive with SMA, and none positive with anti-LKM and anti-LC1. Among anti-SLA positive patients, 58 cases were diagnosed with autoimmune hepatitis (AIH), 12 were AIH/primary biliary cholangitis (PBC) overlap syndrome (OS), 2 were drug-induced liver injury, 2 were chronic hepatitis B, and 3 were hepatitis A, hepatitis E and acquired immune deficiency syndrome (AIDS) with liver injury, respectively.Cases of AIH and AIH/PBC OS accounted for 90.9% (70/77 cases) of anti-SLA-positive patients, and 5 of 7 patients diagnosed with non-AIH (and OS) had elevated IgG, showing AIH feature.92.3% (12/13 cases) of anti-SLA with high titers of AMA were diagnosed as AIH/PBC overlap syndrome. Of the 77 anti-SLA-positive patients, 28 (36.4%) had advanced or end-stage liver disease, including decompensated cirrhosis (22 cases), chronic acute liver failure (4 cases), and liver transplantation (1 case) and death from liver failure (1 case). Conclusions Anti-SLA has high diagnostic specificity for AIH;anti-SLA positive in patients with PBC should be an important biomarker for the diagnosis of AIH/PBC overlap syndrome.

OBJECTIVE To evaluate the efficacy and safety of tyrosine kinase inhibitors （TKI） in the treatment of HER2- positive breast cancer in order to provide evidence-based evidence for clinical medication. METHODS Retrieved from CNKI， Wanfang database， VIP， PubMed， Cochrane Library， Embase and Web of Science， randomized controlled trial （RCT） about TKI （trial group） versus drugs excluding TKI （control group） in the treatment of HER2-positive breast cancer were collected from the establishment of the database to April 2023. Meta-analysis and sensitivity analysis were performed by using RevMan 5.4.1 and Stata 17 software. RESULTS Total of 24 RCT studies were included， involving 15 538 HER2-positive breast cancer patients. The meta- analysis results showed that compared with the control group， the progression-free survival （PFS） [HR＝0.91， 95%CI （0.80， 1.02）， P＝0.12]， overall survival （OS） [HR＝0.95， 95%CI （0.89， 1.01）， P＝0.11]， objective response rate （ORR） [OR＝1.21， 95%CI （0.86， 1.69）， P＝0.27]， and pathological complete response rate （pCR） [OR＝1.44， 95%CI （0.91， 2.27）， P＝0.12] had no statistically significant difference in the trial group； among the 3/4 grade ADRs， the trial group had a higher incidence of anemia [OR＝1.77， 95%CI （1.16，2.70）， P＝0.008]， rash [OR＝11.26， 95%CI （7.32，17.31）， P＜0.000 01]， paronychia [OR＝8.67， 95%CI（1.62，46.53）， P＝0.01]， diarrhea [OR＝10.17， 95%CI（5.03，20.58）， P＜0.000 01]， oral mucositis inflammation [OR＝ 9.34， 95%CI （3.13， 27.83）， P＜0.000 1]， elevated aspartate aminotransferase [OR＝2.09， 95%CI （1.13，3.84）， P＝0.02]， and hypokalemia [OR＝2.37， 95%CI （1.31，4.30）， P＝0.005] than that of the control group. Subgroup analysis results showed that compared with the placebo group， TKI could improve OS and ORR （P＜0.05）， while compared with trastuzumab， TKI had no advantage in PFS， OS， ORR， and pCR， and TKI combined with trastuzumab could significantly improve PFS， OS， ORR， and pCR compared with the trastuzumab group （P＜ 0.05）. Sensitivity analysis suggested that the results were relatively robust and the risk of publication bias was low. CONCLUSIONS Compared with trastuzumab， TKI has no advantages in PFS， OS， ORR and pCR in the treatment of HER2- positive breast cancer， but TKI combined with trastuzumab can significantly improve PFS， OS， ORR and pCR； TKI can increase the risk of grade 3/4 anemia， rash， paronychia， diarrhea， oral mucositis， elevated aspartate aminotransferase， and hypokalemia.