To investigate the clinicopathological features of endometrial endometrioid adenocarcinoma(EEA)with adnexal involvement.Methods The clinicopathological data of 86 EEA patients who underwent surgical treatment at our center from January 2000 to December 2015 were analyzed retrospectively.The clinicopathological features were compared between patients with occult adnexal involvement and those with gross adnexal involvement.Results A total of 86 EEA patients with adnexal involvement(mean age:58.1 years)were included in this study,accounting for 5.4%(86/1592)of the EEA patients during the same period.Among these 86 patients,there were 13 premenopausal patients(15.1%)including 2 premenopausal patients aged under 40 years.Gross adnexal involvement was found in 47 patients(54.7%),while occult adnexal involvement was found in 39 patients(45.3%)in pathology evaluation.Ovarian metastasis was found in 34 patients(39.5%),followed by both ovarian and tubal metastasis in 19 patients(22.1%)and tubal metastasis in 33 patients(38.4%).The expressionss of estrogen receptor(χ=8.086,P=0.042)and progesterone receptor(PR)(χ=9.149,P=0.026)were significantly different between gross adnexal involvement group and occult adnexal involvement group,whereas no significant difference was found in other clinicopathological features(all P>0.05).The non-conditional Logistic regression analysis showed that,compared with PR no-expression group,the rate of occult microscopic adnexal involvement in PR low-expression group was 6.375 times of that of the gross adnexal involvement(P=0.005,95%CI:1.768-22.976),and the rate of occult microscopic adnexal involvement in the PR high-expression group was 3.719 times of that of gross adnexal involvement(P=0.048,95%CI:1.009-13.702). Conclusion PR expression level is remarkably lower in EEA patients with gross adnexal involvement than those with occult adenxal involvement.

Objective To investigate the clinical characteristics of patients with idiopathic pulmonary arterial hypertension (IPAH) in China.Methods A total of 161 patients diagnosed as IPAH in Shanghai Pulmonary Hospital from June 2008 to June 2010 were retrospective analyzed.Results The mean diagnostic age was (33 ± 15 ) years old and 70.2％ patients were female. The median duration from symptoms onset to diagnostic right heart catheterization was 12 months.Incidence of NYHA class Ⅲ to Ⅳ was 56.5％ at diagnosis and the mean six minutes walk distance was limited to (398 ± 108) meters.Incidence of mild obstructive,restrictive and diffusing impairment in pulmonary function test was 7.8％,42.2％ and 82.2％ patients with IPAH,respectively. Right heart catheterization demonstrated severe elevated mean pulmonary arterial pressure [ ( 63 ± 17 ) mm Hg ( 1 mm Hg =0.133 kPa) ] and pulmonary vascular resistance index [ ( 25 ± 12 ) Wood U/m2 ] in this patient cohort.The response rate of acute pulmonary vasoreactivity testing was 8.7％ in this cohort. Compared with non-responders,responders to acute pulmonary vasoreactivity testing were younger and with less severe pulmonary hypertension. Among non-responders,89％ patients were treated by one specific anti-pulmonary arterial hypertension drug and 27％ patients received combined anti-pulmonary arterial hypertension medications.Conclusions Young female was predominantly involved in patients with IPAH in China.The diagnosis of IPAH is often made at advanced disease stage and majority patients with IPAH received specific anti-pulmonary arterial hypertension therapies in this patient cohort.

Objective To assess the clinical value of HPV genotyping in follow-up after treatment for cervical high grade squamous intraepithelial lesion (HSIL). Methods Two hundred and thirty eight patients with HSIL receiving conization in Cancer Hospital, Chinese Academy of Medical Sciences from Dec, 2006 to Jan, 2009 were accrued in our study. All the patients were prospectively observed after conization every 6 months for 3 times or till histologically confirmed recurrence. The items in every visit included pelvic examination, cervical cytology and HPV genotyping. Twenty-one HPV genotypes were detected by PCR-hybridization method. The last follow-up was July 31, 2010, and the median follow-up time was 28.3 months (range 6.5-43.0 months). Kaplan-Meire method as used for analyzed the median recurrent time, and the relationships between HPV status and recurrent disease were calculated by and log-rank test and Cox-regression model. Results Among the 238 patients, 110 cases (46.2%, 110/238) had positive result of HPV DNA testing at any visit. The most common HPV types detected in follow-up were HPV16 (45.6%), HPV58 (26.5%), and HPV52 (16.9%). There was no correlation between recurrent disease and any individual high risk HPV infections (P>0.05). Seventeen recurrent cases (7.1%) were identified in 238 patients within a median recurrent time of 14.9 months (range 6.0-32.1 months). In univariate analyses, HPV positive at any visit, persistent infection, multiple infection, type specific persistent infection and positive HPV at 18 months after conization were indicators for residual/recurrent disease (P<0.05). In multivariate analysis, only multiple HPV infection (HR=8.6, 95%CI:1.8-41.7, P=0.008) and type specific persistent HPV infection (HR=5.1, 95%CI: 1.0-24.8, P=0.042) had an elevated risk of recurrent disease. Conclusions HSIL with multiple HPV infection and type specific persistent HPV infection in follow-up are at high risk of recurrent disease. Patients with HPV turning into negative within 18 months after treatment have a low risk of recurrence.

OBJECTIVETo evaluate the efficacy and toxicity of paclitaxel with low-dose cisplatin and 5-fluorouracil continuous infusion in the treatment of advanced gastric carcinoma.

METHODSThe patients were treated with paclitaxel liposome 60 mg/m(2) i.v. gtt on d1, 8, 15, DDP 15 mg×m(-2)×d(-1) by i.v. gtt on d1-5, 5-Fu 500 mg×m(-2)×d(-1) by civ for 120 h, administered every 21 days.

RESULTSOut of the whole group, 3 cases achieved CR, 29 cases achieved PR with an ORR of 54.2% and median TTP of 7.1 months. Out of 40 cases in the primary treatment, 3 cases achieved CR, 22 cases achieved PR with an ORR of 62.5% and median TTP of 7.6 months. Out of 20 evaluable retreated cases, no case achieved CR, 7 cases achieved PR with an ORR of 36.8% and median TTP 6.3 months. The main toxicities were hematological toxicities, nausea and vomiting of grade I-II.

CONCLUSIONThe combination regimen of paclitaxel, low-dose cisplatin and 5-fluorouracil is effective and well tolerated for patients with advanced gastric carcinoma, especially for primary treatment cases. It is worthy of further study.

Adenocarcinoma ; drug therapy ; pathology ; secondary ; surgery ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; therapeutic use ; Cisplatin ; administration & dosage ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Leukopenia ; chemically induced ; Liposomes ; Liver Neoplasms ; drug therapy ; secondary ; Male ; Middle Aged ; Nausea ; chemically induced ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; adverse effects ; Remission Induction ; Stomach Neoplasms ; drug therapy ; pathology ; surgery ; Survival Rate ; Vomiting ; chemically induced ; Young Adult

Z-Ligustilide, a major phthalide isolated from a widely used traditional Chinese medicine Ligusticum chuanxiong, possesses various pharmacological activities including neuroprotective, anti-inflammatory, antiproliferative and vasorelaxing effects. However, it is unstable and inclined to degrade in natural conditions, which limits its study and application greatly. In this study, degradation behavior of Z-ligustilide and its degradation products stored at room temperature under direct sunlight were investigated and structure elucidated by HPLC-UV, UPLC-QTOF-MS and NMR. Z-ligustilide degradation and total five degradation products were generated and detected. Two degradation products were unequivocally identified as senkyunolide I and senkyunolide H by comparison with reference compounds. Another two degradation products were further isolated by semi-preparative HPLC and structure elucidated as (E)-6, 7-trans-dihydroxyligustilide and (Z)-6, 7-epoxyligustilide by 1H and 13C NMR, respectively. The degradation pathways of Z-ligustilide were finally proposed. Oxidation, hydrolysis and isomerization are the major degradation reactions.
4-Butyrolactone ; analogs & derivatives ; isolation & purification ; metabolism ; Benzofurans ; metabolism ; Chromatography, High Pressure Liquid ; Hydrolysis ; Ligusticum ; chemistry ; Magnetic Resonance Spectroscopy ; Metabolic Networks and Pathways ; Oxidation-Reduction ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Objective To explore the efficacy of pancreatic kallidinogenase enteric-coated tablet combined with irbesartan tablet in the treatment of elderly patients with type 2 diabetic nephropathy(DN).Methods Elderly patients with type 2 DN were selected as the research subjects,and were randomized into control group and treatment group.The control group was given 150 mg of irbesartan tablets once a day,while the treatment group was given 240 U of pancreatic kallidinogenase enteric-coated tablets three times a day on the basis of the control group.The clinical efficacy,renal function indicators[serum creatinine(SCr),blood urea nitrogen(BUN),urinary albumin excretion rate(UAER)],hemodynamic indicators[fibrinogen(FIB),whole blood viscosity,hematocrit(HCT)],microvascular lesion indicators[vascular endothelial growth factor(VEGF),soluble intercellular adhesion molecule-1(sICAM-1)],B-ultrasound detection indicators[maximum aortic flow velocity(Vmax),minimum diastolic flow velocity(Vmin),resistance index(RI)at the renal hilum]before and after treatment and adverse drug reactions were compared between both groups.Results After treatment,the total effective rates in control group and treatment group were 85.42％and 97.92;SCr levels were(90.47±18.14)and(80.28±12.04)μmol·L-1;BUN levels were(7.24±1.34)and(6.54±1.21)mmol·L-1;UAER levels were(36.17±6.07)and(31.04±5.21)μg·min-1;FIB levels were(4.32±0.59)and(3.95±0.48)g·L-1;whole blood viscosity values were(7.38±1.15)and(6.81±0.98)mPa·s;HCT levels were(38.63±7.01)％and(36.17±6.48)％;VEGF levels were(254.18±45.59)and(212.14±40.48)pg·mL-1;human sICAM-1 levels were(336.40±61.57)and(295.30±58.46)pg·L-1;the Vmax of renal artery were(72.58±3.60)and(74.98±3.78)cm·s-1;the Vmin values were(22.48±3.14)and(24.83±3.63)cm·s-1;the RI values were 0.73±0.06 and 0.68±0.07,respectively.There were statistical differences in the above indicators between control group and treatment group(all P＜0.05).The total incidence eares of adverse drug reactions in control group and treatment group were 4.17％(2 cases/48 cases)and 8.33％(4 cases/48 cases)respectively(P＞0.05).Conclusion Pancreatic kallidinogenase enteric-coated tablet combined with irbesartan tablet can effectively improve the renal function of elderly patients with type 2 DN,improve the blood flow and delay microvascular lesion,and enhance the efficacy,therefore it is safe and effective.

OBJECTIVETo explore the infarct sites in patients with inferior wall acute myocardial infarction (AMI) concomitant with ST segment elevation in leads V1-V3 and leads V3R-V5R.

METHODSFive patients diagnosed as inferior, right ventricular, and anteroseptal walls AMI at admission were enrolled. Electrocardiographic data and results of isotope 99mTc-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and coronary angiography (CAG) were analyzed.

RESULTSElectrocardiogram showed that ST segment significantly elevated in standard leads II, III, aVF, and leads V1-V3, V3R-V5R in all five patients. The magnitude of ST segment elevation was maximal in lead V1 and decreased gradually from lead V1 to V3 and from lead V1 to V3R-V5R. There was isotope 99mTc-MIBI myocardial perfusion imaging defect in inferior and basal inferior-septal walls. CAG showed that right coronary artery was infarct-related artery.

CONCLUSIONSThe diagnostic criteria for basal inferior-septal wall AMI can be formulated as follows: (1) ST segment elevates > or = 2 mm in lead V1 in the clinical setting of inferior wall AMI; (2) the magnitude of ST segment elevation is the tallest in lead V1 and decreases gradually from lead V1 to V3 and from lead V1 to V3R-V5R. With two conditions above, the basal inferior-septal wall AMI should be diagnosed.

Aged ; Coronary Angiography ; Diagnostic Errors ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; diagnostic imaging ; physiopathology ; Radionuclide Imaging

OBJECTIVE: To investigate the effects of 1,2-dichloroethane( 1,2-DCE) on myelin basic protein( MBP),neuron specific enolase( NSE) and S100 protein in the plasma of SD rats. METHODS: Forty-eight specific pathogen free adult SD rats were randomly divided into control group,low-dose group and high-dose group,with 8 females and 8 males in each group. Rats were given 1,2-DCE orally at the dose of 0,27 and 79 mg / kg body weight every other day( every Wednesday,Monday and Friday) for 4 weeks. After 1,2-DCE administration,8 survived rats( half male and female) were randomly selected in each group. The plasma levels of MBP,NSE and S100 protein were measured using enzyme-linked immunosorbent assay. The blood and urinary samples were collected to assess the concentration of 1,2-DCE and its main metabolites( 2-chlorideacetic acid, 2-chlorideacetaldehyde and 2-chlorideethanol) by gas chromatography. The pathological changes of cerebrum and cerebellum were observed through optical microscope,and the expression of MBP was detected by immunohistochemistry. RESULTS: Rats in high-dose group showed abnormal behavior from the third day of1,2-DCE exposure and 6 rats( 2 females,4 males) died from 1,2-DCE intoxication. Rats in low-dose group and control group appeared normal and no death was observed. MBP level in the plasma of high-dose group was higher than that in the control group( P < 0. 05),but the levels of NSE and S100 protein in each group did not show significant statisticaldifference( P > 0. 05). 1,2-DCE and 2-chloroethanol in the urine were detected in the high-dose group,and were below detection limit in the other two groups. 2-Chloroacetic acid level in high dose-group was significantly higher than that in the low-dose group( P < 0. 05),and was below detection limit in the control group. 2-Chloroacetaldehyde in the urine of each group was below detection limit. 1,2-DCE and its 3 kinds of metabolites were not detected in the plasma of all rats. There was no obvious structural damage,bleeding,edema or necrosis found in the cortex and white matter of cerebrum and cerebellum. The expression of MBP in the choroid plexus epithelial cells were significantly enhanced in the lateral ventricle and the fourth ventricle of rats in the high-dose group,and slight enhanced in rats in the low-dose group. CONCLUSION: MBP may play a role in the toxic effect of 1,2-DCE.