Objective To evaluate the lymphoscintigraphic imaging characteristics for the patients with lower limb lymphedema and to establish a novel grading system for the injury to lower limb lymphatic system. Methods One hundred and sixty six consecutive patients (332 lower limbs) with lower limb lymphedema after surgical and(or) radiotherapy treatment for gynecological cancer were recruited into this retrospective study. The lymphoscintigraphy studies were performed after subcutaneous injection of 111～185 MBq (0. 1～0. 15 ml) of 99Tcm-DX into the webbed space between the first and second toes of both feet. Based on the integrity of lymphatic vessel and the extension of dermal diffusion on lymphoscintigram,the lymphatic injury to the lower limb was graded as 0, 1,2 and 3 respectively. The lymphedema of the limb was staged as 0, Ⅰ , Ⅱ a, Ⅱ b, Ⅲ by the standard of Consensus Document of the International Society of Lymphology (ISL). Chi square test was carried out to validate the established grading system for the assessment of the injury to the lower limb lymphatic system. Results The lymphoscintigraphic imaging characteristics included lymphatic blockage, dermal backflow, no visualization of lymphatic or lymph node, lymphocele and lymph fistula in the lower limb, pelvis and abdomen. There were 65 (19.6%), 71 (21.4%),131 (39.5%), 62 (18.7%) and 3 (0.9%) limbs staged as 0, Ⅰ , Ⅱa, Ⅱb, and Ⅲ for lymphedema while 36(10.8%), 79(23.8%), 116(34.9%) and 101 (30.4%) limbs graded as 0, 1, 2, and 3 for lymphatic injury. There was a statistically significant correlation between the grading methods (χ2 =313.483, P <0.001). The patients who underwent radiotherapy had a higher incidence rate of grade 2 and 3 (70.5%, 158/224) than those who underwent surgery (53.6%, 59/108) (χ2 = 9.662, P = 0.022).The patients with erysipelas had a higher incidence rate of grade 3(73.1%, 38/52) than those without erysipelas (43.9%, 50/114) (χ2= 12.238, P<0.001). The incidence rate of grade 3 increased with the duration of lymphedema after treatment: 36.6% (34/93) for less than 1.5 years, 72.3% (34/47) for between 1.5 to 5 years, and 76.9% (20/26) for more than 5 years (χ2 = 23.123, P<0.001). The grade of lymphatic injury showed no significant difference among 3 types of gynecological cancers (χ2 = 4.000, P =0.676), or between the patients with and without chemotherapy (χ2 =0.411, P=0.938). Conclusions Lymphoscintigraphy is a reliable modality to diagnose lower limb lymphedema after treatment for gynecological cancer. The injury grading system could provide objective assessment of the lymphatic damage.

BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been popular in the treatment of patients with cardiac arrest (CA). However, the effect of ACD-CPR versus conventional standard CPR (S-CRP) is contriversial. This study was to analyze the efficacy and safety of ACD-CPR versus S-CRP in treating CA patients. METHODS: Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase "active compression-decompression cardiopulmonary resuscitation and cardiac arrest" in PubMed, EmBASE, and China Biomedical Document Databases. The Cochrane Library was searched for papers of meta-analysis. Restoration of spontaneous circulation (ROSC) rate, survival rate to hospital admission, survival rate at 24 hours, and survival rate to hospital discharge were considered primary outcomes, and complications after CPR were viewed as secondary outcomes. Included studies were critically appraised and estimates of effects were calculated according to the model of fixed or random effects. Inconsistency across the studies was evaluated using the I2 statistic method. Sensitivity analysis was made to determine statistical heterogeneity. RESULTS: Thirteen studies met the criteria for this meta-analysis. The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP. Totally 234 CA patients were found out hospitals, while the other 333 CA patients were in hospitals. Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality. ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99–1.97), 1.94 (95%CI 1.45–2.59) and 2.80 (95% CI 1.60–5.24). No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06 (95% CI 0.76–1.60) and 1.00 (95% CI 0.73–1.38). CONCLUSION: Quality controlled studies confirmed the superiority of ACD-CPR to S-CRP in terms of ROSC rate and survival rate at 24 hours. Compared with S-CRP, ACD-CPR could not improve survival rate to hospital admission or survival rate to hospital discharge.

OBJECTIVETo explore the activation and proliferation of specific T cells induced by artificial antigen-presenting cells (aAPCs) simulated dendritic cells (DCs) and to observed the effect of these T cells on leukemic cell killing.

METHODSaAPCs were developed by coating a human leukocyte antigen-immunoglobulin fusion protein ( HLA-lg), which was connected each one of the four CML28 antigen epitopes (DLMSSTKGL, DLMSSTKGL, ALFCGVACA, VLTFALDSV), and CD28-specific antibody, to magnet-beads CML cell specific peptides (CML28) served as target peptides. Bone marrow (BM) or peripheral blood (PB) mononuclear cells (MNCs) were isolated from HLA-A2 healthy volunteers, and co-cultured with aAPCs. Specific T lymphocyte were detected by flow cytometry. The fresh acute leukemic cells were used as target cells. The specific T cells incubated with leukemic cells for 4 h at ratios of 5:1, 10:1, 20:1, 40:1, 80: 1, respectively. The effect of leukemic cells killing was detected by lactate dehydrogenase release test.

RESULTSThe average ratio of CML-28 specific T lymphocyte in control group was (2.2 +/- 0.4)% and in experimental groups (DLMSSTKGL, DLMSSTKGL, ALFCGVACA, VLTFALDSV) were (13.5 +/- 1.6)%, (15.2 +/- 1.5)%, (14.7 +/- 1.8)% and (34.3 +/- 3.5)%, respectively, being significantly higher than that in control group (P < 0.01). Induction efficiencies of acute leukemic cells killing were significantly enhanced by increase of effector cells. The cytotoxic activity of specific T lymphocyte in one experimental group (VLTFALDSV) was much higher than that in other three experimental group (P < 0.05).

CONCLUSIONThis "prime and expand" regimen should be an alternative method for large scale amplification of rare tumor-specific CTLs and aAPCs might be a useful tool for leukemia immunotherapy.

Adolescent ; Adult ; Antigen-Presenting Cells ; immunology ; Cell Proliferation ; Cells, Cultured ; Coculture Techniques ; Cytotoxicity, Immunologic ; Female ; Humans ; Leukemia ; immunology ; pathology ; Lymphocyte Activation ; Male ; Middle Aged ; T-Lymphocytes ; cytology ; immunology ; Young Adult

Huperzine A is a potent,reversible,and blood-brain barrier permeable acetylcholinesterase irhibitor.The aim of this study was to compare the pharmacokinetics,tolerability,and bioavailability of two formulations with the established reference formulation of huperzine A in a fasting,healthy Chinese male population.This was a randomized,single-dose,3-period,6-sequence crossover study.The plasma concentrations of huperzine A were determined by liquid chromatography tandem mass spectrometry.Tolerability was assessed based on subject interview,vital sign monitoring,physical examination,and routine blood and urine tests.The mean (SD) pharmacokinetic parameters of the reference drug were Cmax,1.550 (0.528) ng/mL;t1/2,12.092 (1.898) h;AUC0-72h,17.550 (3.794) ng.h/mL.Those of the test formulation A and test formulation B were Cmax,1.412 (0.467),1.521 (0.608) ng/mL;t1/2,12.073 (2.068),12.271 (1.678) h;AUC0-72h,15.286 (3.434) ng.h/mL,15.673 (3.586) ng.h/mL.The 90％ confidence intervals for the AUC0-72h and Cmax were between 0.80 and 1.25.No adverse events were reported by the subjects or found with results of clinical laboratory test.The test and reference products met the regulatory criteria for bioequivalence in these fasting,healthy Chinese male volunteers.All three formulations appeared to be well tolerated.

OBJECTIVETo investigate the anatomic feature of the canal isthmus of mandibular permanent incisors by Micro-CT.

METHODSThirty-three mandibular permanent incisors with two canals were selected through the radiograph in proximal view. These teeth were then scanned using Micro-CT and reconstructed. The scanning layer thickness was 20 microm. We observed the apical 6 mm of the 33 roots, and 300 sections were gained each tooth, giving a total of 9900 sections. The numbers of canals at each level in the apical 6 mm were recorded. The numbers of sections showing isthmuses at each level of the root canals were recorded too. Data were analyzed using the Chi-square statistic to test the null hypothesis that location of the sections in each of the apical 6 mm and presence of the isthmus were independent. The minimum root canal wall thickness was measured in each of the apical 6 mm of the roots.

RESULTSIsthmuses were found to be present at all levels with prevalence from 10.0% to 85.5%. The Chi-square test indicated a significant difference in the distribution of isthmuses with section (P = 0.0O1). The incidence of isthmuses was higher at the apical 3-6 mm level, and the highest incidence (85.5%) was at 5 mm level. There were many more sections containing complete isthmuses (49.7%) than those containing partial isthmuses (4.5%). The thickness of the minimum root canal was less than 0.5 mm.

CONCLUSIONThe mandibular incisors have a high incidence of isthmus and are narrow in proximal direction. Debridement of the isthmus is a major challenge during surgical and nonsurgical root canal treatment.

Dental Pulp Cavity ; Humans ; Incisor ; Mandible ; Molar ; Tooth Apex ; X-Ray Microtomography

OBJECTIVETo explore the relationship between changes in ideal cardiovascular health score(ΔICHS) and the carotid intima-media thickness(CIMT) among the middle age and elderly population.

METHODSA total of 5 852 cases were enrolled from 101 510 Kailuan Group employees who participated in the health examination in 2006-2007 and 2010-2011 through stratified random sampling. A total of 5 440 individuals met the inclusion criteria (≥40 years old; no history of stroke, transient ischemic attack, or myocardial infarction). CIMT was measured by ultrasound during 2010-2011 examination. Excluding individuals with incomplete data, 4 367 cases were included for the final analysis. According to the AHA definition of ideal cardiovascular health metric, individual ΔICHS was evaluated and the subjects were divided into 3 groups: group reduced (ΔICHS<0, n=1 355), invariant group (ΔICHS=0, n=1 451) and elevated group (ΔICHS>0, n=1 561). ΔICHS was derived from the difference between 2010-2011 and 2006-2007. Multivariate linear regression and logistic regression analysis were used to analysis the relationship between ΔICHS and CIMT.

RESULTSThe ICHS was 3.03 ± 1.27 in 2006-2007 study population and 3.09 ± 1.40 (P<0.01) in 2010-2011 study population. Multivariate linear regression analysis showed that ΔICHS was inversely related to CIMT. For every 1 score increase in ΔICHS, CIMT decreased by 0.009 mm(B=-0.009, P<0.01). Multivariate logistic regression analysis showed that after adjusting for multiple confounding factors, the risk of CIMT wall thickening was lower in the ΔICHS invariant group (OR=0.73, 95%CI: 0.59-0.91) and in ΔICHS elevated group(OR=0.66, 95%CI: 0.52-0.82) compared to the ΔICHS reduce group.

CONCLUSIONElevated ΔICHS is an independent protective factors of CIMT increase in the middle age and elderly population.

Aged ; Cardiovascular System ; Carotid Intima-Media Thickness ; Humans ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; Stroke

BACKGROUNDThe efficacy and safety evidence of bortezomib in multiple myeloma (MM) patients with hepatitis B is vacant. This study aimed to investigate the efficacy and safety of bortezomib in MM patients with hepatitis B in China.

METHODSFrom 2006 to 2011, 739 newly diagnosed MM patients were screened for serum hepatitis B virus (HBV) biomarkers. HBV-infected patients were followed for HBV reactivation by monitoring of serum alanine transaminase (ALT) and HBV DNA load. The pattern of HBV reactivation in relation to bortezomib was evaluated. Seven hundred thirty-nine MM patients were included in this study.

RESULTSThe prevalence of MM patients infected with HBV was 3.4% (n = 25), of which 17 cases were treated with bortezomib. Bortezomib had no significant influence on liver function (ALT before and after treatment: 36.69 ± 8.90 U/L vs. 11.31 ± 2.74 U/L, P = 0.19) and HBV DNA of MM patients with HBV (detectable HBV DNA percentage: 5.9% vs. 11.8%, P = 0.12).

CONCLUSIONSBortezomib can be used safely and effectively in MM patients with hepatitis B. HBV prophylaxis and surveillance are recommended during the MM treatment.

Aged ; Antiviral Agents ; therapeutic use ; Bortezomib ; therapeutic use ; DNA, Viral ; drug effects ; genetics ; Female ; Hepatitis B ; drug therapy ; virology ; Hepatitis B virus ; drug effects ; pathogenicity ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; drug therapy ; virology ; Retrospective Studies ; Viral Load

OBJECTIVETo investigate association of vitamin D receptor (VDR) gene polymorphisms with the susceptibility to chronic periodontitis (CP) of Han Nationality.

METHODSBuccal swabs from 166 patients with severe, moderate and mild CP respectively and 80 matched control individuals were collected. DNA was extracted from these buccal swabs using Chelex-100 method. VDR BsmI, ApaI, TaqI were tested with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The distribution of the genotypes and allele frequencies in the patient and control groups were analyzed.

RESULTSThe frequency of VDR ApaI allele A was significantly higher among patients with CP than controls. Frequencies of VDR ApaI allele A were significantly higher in severe CP patients than in moderate CP and mild CP respectively. There was no significant difference in the genotype distribution or the allele frequencies of VDR BsmI and TaqI between the controls and CP patients.

CONCLUSIONSThese data indicate that VDR ApaI allele A may be related to the susceptibility to CP in Han Nationality.

Adult ; Aged ; Alleles ; Asian Continental Ancestry Group ; genetics ; Chronic Periodontitis ; genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic ; Receptors, Calcitriol ; genetics

Rheumatoid arthritis (RA) is an autoimmune disease. It is the focus of current treatment to improve the immune disorders of RA patients and reduce the inflammatory damage. Acupuncture and moxibustion show the advantages of simple operation and safety. It has remarkable curative effect in the treatment of RA, and has a variety of intervention methods, including conventional acupuncture, moxibustion, combination of acupuncture and moxibustion, as well as innovative acupuncture and moxibustion therapies such as electroacupuncture and spinal moxibustion. The immune regulation of acupuncture and moxibustion on RA has the characteristics of bidirectional and multi-target. It can regulate Th17/Treg cell balance, Th1/Th2 cell balance, specific protein and NF-κB and other signaling pathways to regulate inflammatory immune response.

This study was aimed to investigate the effect of artificial antigen-presenting cells (aAPCs) on inducing activation and proliferation of specific T-lymphocytes through stimulating biological function of dendritic cells with aAPCs in vitro. The specific antigen of chronic myeloid leukemia CML-28 was screened as objective antigen peptide by using magnetic microbeads as vector; the CML-28 epitope sequence (Vltfaldsv) was obtained by antigen epitope prediction software; this epitope was coupled with MHC molecule and used as first signal molecule, the B7-1 molecule was used as second signal molecule; these 2 molecules simultaneously were loaded onto surface of magnetic microbeads so as to contract aAPC complex. The bone marrow mononuclear cells were derived from HLA-A2(+) healthy bone marrow donors, CD8(+) T lymphocytes were screened and co-cultured with aAPC complex. During culture the 5, 6-carboxyfluorescein diacetate succinimidyl ester (CFSE) was added and proliferation of T-lymphocytes was detected by CPSE and proliferation level of specific T lymphocytes was detected by flow cytometry. The results showed that the proliferation level of CML-28 specific T lymphocytes obviously increased in experimental group, average level was 17.34 +/- 0.65%, while average level in control was 2.25 +/- 0.43%, there was significant difference between them (p < 0.01). It is concluded that the aAPC complex can mimic human APCs in vitro, and stimulate activation and proliferation of CD8(+) specific T lymphocytes.
Adolescent ; Adult ; Antigen Presentation ; immunology ; Antigen-Presenting Cells ; immunology ; metabolism ; Antigens, Neoplasm ; immunology ; Biomimetics ; methods ; CD8-Positive T-Lymphocytes ; immunology ; Female ; HLA-A2 Antigen ; immunology ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; immunology ; Lymphocyte Activation ; Male ; Middle Aged ; Tissue Donors ; Young Adult