Objective To analyze the therapeutic effect of emergency surgery in the treatment of severe valvular heart disease and its influence on heart function.Methods 87 cases with severe valvular heart disease were selected,and they were given emergency surgical treatment.Before and after treatment,the cardiac function index[end -diastolic volume (EDV),end-systolic volume (ESV),left ventricular end systolic volume index (LVESVI),left ventricular end-diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF)],postoperative complications and survival rate were compared.Results After treatment,the EDV [(125.78 ± 31.67) mL],ESV [(71.30 ± 16.58) mL] and LVESVI [(50.39 ± 13.30) mL/m2],LVEDVI [(88.74 ± 13.51) mL/m2],LVEF [(51.48 ± 12.73) ％] were better than those before treatment [(116.48 ± 28.94) mL,(63.26 ± 15.47) mL,(33.27 ± 8.54) mL/m2,(64.47 ± 12.69)mL/m2,(47.53 ± 11.20)％],the differences were statistically significant (t =2.022,2.022,3.307,12.213,2.173,all P ＜ 0.05).The incidence rate of complications was 24.14％ (21/87),included arrhythmia in 4 cases,low cardiac output syndrome in 8 cases,acute renal failure in 9 cases.Postoperative 1 year,2 years,the survival rates were 91.95％ (80/87),85.06％ (74/87),respectively.Conclusion Emergency surgical treatment for severe valvular heart disease can effectively improve cardiac function index,improve the survival rate.

BACKGROUND:Granulocyte colony-stimulating factor (G-CSF) can strongly mobilize bone marrow hematopoietic stem cells (HSCs). It has been proved that G-CSF has the ability to mobilize both HSCs and mesenchymal stem cells (MSCs).OBJECTIVE:To investigate the therapeutic effect of G-CSF in mobilizing autologous bone marrow stem cells entering cerebral infarction zone on ischemic cerebral infarction in rats.DESIGN:A randomized grouping design, animal experiment.SETYING: Center for Stem Cell Biology and Tissue Engineering of Sun Yat-sen University.MATERIALS: This experiment was carried out at the Animal Experimental Department of Sun Yat-sen University (North District) and Center for Stem Cell Biology and Tissue Engineering of Sun Yat-sen University from September 2004 to January 2005. Totally 200 male Wistar rats were chosen and randomly divided into autologous bone marrow stem cells transplantation group and control group, with 100 rats in each group.METHODS:Rats of two groups were made cerebral infarction models by line occlusion. Transplantation group introduced intraperitoneal injection of 60 μg/kg G-CSF one hour after operation. The control group introduced intraperitoneal injection of saline of the same dosage at the same time. ①All rats were weighed before operation and 24 hours, 48 hours, one week after operation to evaluate body mass loss rate. They were also given neurological grading. Grading criteria: Grade 0 is normal. Grade Ⅰ is that the right forelimb bends. Grade Ⅱ is that the right forelimb grasped weakly when the tail is lifted. Grade Ⅲ is that the rat has no directivity in automatic action and circumrotates to right when the tail is lifted. Grade Ⅳ is that the rat circumrotates to right in automatic action. ②15 rats in each group were selected. 24 hours, 48 hours, one week after operation, we opened the skulls, took out the brain and used 2,3,5-Triphenyltetrazoluim Chloride (TTC) staining to measure infarction volume, hematoxylin-eosin(HE) staining to observe the pathological change , and immunohistochemistry to detect the infiltration of CD34+ cells.MAIN OUTCOME MEASURES:Body mass loss rate, neurological grade,infarction volume, pathological change and infiltration of CD34+ cells.RESULTS: Totally 180 of 200 rats were successfully made cerebral infarction model. 48 rats died in seven days after operation. As a result, 132 rat models were alive and 120 rats were randomly selected for data analysis. ①Measurement of body mass and neurological grading: There was no significant difference in body mass loss rate between two groups 24 hours and 48 hours after operation (P ＜ 0.05);one week after operation, body mass loss rate was significantly lower in transplantation group [(10.5±8.2)%]than in control group [(17.8±7.1)%] (P ＜ 0.05). There was no significant difference in neurology grade between two groups. ②Infarction volume:Infarction volume and the percent of infarction volume in the whole brain in control group were all higher than those in the transplantation group,with significant difference [ (251.69±52.77) mm3 vs(145.72±28.05)mm3,(17.00±2.69)% vs (9.90±1.62)% ,P ＜ 0.01]. ③Pathological change: 24 hours after operation, the brain tissue of two groups got classical pathological change of cerebral ischemia infarction. There were some mono-nucleus cells infiltrating in transplantation group while none in control group. 48 hours after operation, most nerve cells disappeared and the glial cells were degenerated. There were many mono-nucleus cells infiltrating in transplantation group while a few in control group. One week after operation, tissues in the infarction zone were liquescent with many monocaryons and lymphocytes infiltrating around them in control group. In transplantation group, part of the infarction zone was plerosised through proliferation of newly born capillaries and glial cells and inflammatory cells were not evident. ④Immunohistochemistry: CD34+ mono-nucleus cells were detected in the ischemic territory in transplantation group 24 hours after operation while none in the brain of other side and control group. There were CD34+ mono-nucleus cells and pyramidate cells with mutations in transplantation group 48 hours after operation while none in the brain of other side and control group.CONCLUSION:The stem cell transplantation in situ therapy, which employs self-marrow stem cells mobilized by G-CSF can relieve the ischemic degree and reduce the infarction volume.

Objective To explore the relevance between lymphatic metastasis and CT findings in colorectal cancer,and to estab-lish the logistic regression model to realize CT prediction for N staging in colorectal cancer.Methods Take 53 patients with complete data and colorectal cancer confirmed by pathology,and conduct correlation and regression analysis on pathological results based on the size,shape,density,edge and distribution characteristics of the regional lymph nodes that were expressed on CT images.Results It was predicted that patients with colorectal cancer showed lymph node metastasis,a number of lymph nodes with the minor axis≥ 8 mm and the irregular margin were selected in Logistic stepwise regression,the sensitivity of probabilistic model was predicted to be 85.7 %,specificity was 91.7 % and accuracy was 88.9 %;predict whether it had N2 stage,a number of lymph nodes with the heterogeneous density and the fuzzy margin were selected in Logistic stepwise regression,the sensitivity of probabilistic model was predicted to be 60.0 %,specificity 94.3 % and accuracy 86.7 %.Conclusion Lymph nodes with minor axis ≥ 8 mm,irregular margin,and heterogeneous density were the most important indicators for N staging in colorectal cancer,the combination and weigh-ting of these indicators can improve the accuracy of N staging in colorectal cancer.

OBJECTIVE:To provide reference for rational use of anti-tumor essential medicine in the clinic. METHODS:The application of anti-tumor essential medicine in 39 hospitals from Chongqing area during 2012-2014 was analyzed statistically in re-spects of consumption sum,DDDs,DDC and B/A. RESULTS:The total consumption sum of anti-tumor essential medicine in 39 hospitals from Chongqing area during 2012-2014 increased from 10 083.65 ten thousand yuan to 15 186.65 ten thousand yuan,with annual increase rate of 22.72%. 3-year total consumption sum was 37 952.45 ten thousand yuan,and the sum of consumption sum of top 10 medicines was 36 742.24 ten thousand yuan,accounting for 96.81%;top 3 medicines were paclitaxel,oxaliplatin and flu-orouracil. During 2012-2014,DDDs had changed to certain extent,and the front medicines contained tegafur,paclitaxel and cyclo-phosphamide,etc;the most increment medicine was paclitaxel (oral),whose annual growth rate was 59.63%;that of tamoxifen decreased year by year,with annual decrease rate of 5.14%. DDC of paclitaxel,oxaliplatin and etoposide were the higher others. Annual B/A of oxaliplatin,fluorouracil and cytosine arabinoside were all lower than 1.00. CONCLUSIONS:The lonsumption sum and DDDs of anti-tumor essential medicine had increased reasonably in 39 hospitals from Chongqing area during 2012-2014,while their DDC had kept stable. Main medicines used in the clinic are suitable for numerous indications,and are expensive.

OBJECTIVE:To provide reference for ration use of TCM injection. METHODS:The utilization of TCM injections in 39 hospitals from Chongqing area during 2012-2014 was analyzed statistically in respects of consumption sum,DDDs,DDC and B/A. RESULTS:The total consumption sum of TCM injections increased slowly in 39 hospitals from Chongqing area during 2012-2014,increasing from 767 581 thousand yuan to 911 759 thousand yuan,with annual growth rate of 8.98%. Total sum of consumption sum of top 10 drugs was 1 326 019.7 thousand yuan,accounting for 51.11% of total. The consumption sum of Hong-hua injection and Shenxiong glucose injection always took up the first 2 places in those years. DDDs of Xuesaitong injection, Shenxiong glucose injection glucose,Honghua injection and Shuxuetong injection always took up the first 4 places in those years. DDC of Xuebijing injection and Kanglaite injection always took up the first and second places in those years. Among top 10 TCM injection in the list of consumption sum,most of B/A was lower than 1.00;B/A of Shuxuetong injection,Xingnaojing injection, Shenqiong glucose injection and Xueshuantong injection were close or equal to 1.00. Xuesaitong injection was the one that B/A>1.00 from beginning to end. CONCLUSIONS:Total use of TCM injection increased steadily and drug use relatively concentrated in 39 hospitals from Chongqing area during 2012-2014,and rationality of drug use by physicians had been improved gradually.

Severe liver diseases such as liver failure and acute decompensated cirrhosis have critical conditions and high mortality rates,and the prognosis of such patients is closely associated with early warning,timely dynamic assessment,and comprehensive and effective therapy.The patients require a series of effective clinical management measures for elimination of causative factors,organ support,and prevention and treatment of complications.Medical treatment-artificial liver-liver transplantation is an important modality for severe liver diseases.Granulocyte colony-stimulating factor,stem cell therapy,and bioartificial liver have a promising future,while there are still controversies over non-selective β-blocker.This article reviews the hotspots in the clinical management of severe liver diseases.

Background and purpose: The incidence of breast cancer increases as patients age, elderly patients account for a large proportion. Due to the insufifcient systemic therapy, more complications and poorly physical condition, the prognosis of elderly patients is often worse than the younger. The aim of this study was to investigate the safety and tolerance with non-anthracyclin regimen as adjuvant chemotherapy in elderly breast cancer patients. Methods:From Nov. 2008 to Jan. 2012, 56 patients (≥65 years) after surgical excision were enrolled into this study. The patients were divided into two groups:TC and PC groups. Each patient received 4 or 6 cycles of chemotherapy of PC (175 and 600 mg/m2, respectively;n=21) or TC (75 and 600 mg/m2, respectively;n=35), administered intravenously every 3 weeks, as adjuvant chemotherapy. Radiation therapy (as indicated) and endocrine therapy, for patients with hormone receptor-positive disease, were administered after completion of chemotherapy. Results: In this study, 50 patients completed chemotherapy as plan, the proportion of two groups were above 90%. After a median follow-up of 33 months, the median disease-free survival(DFS) and overall survival(OS) were not reached. The relapse-free rate and survival rate were 89.5%and 100%in the PC regime group, which were 90.3%and 96.8%in the TC regime group. Major toxicities included:neutropenia, leucopenia, alopecia, nausea, vomiting and various degree of peripheral neuropathy. The incidence of gradeⅢ-Ⅳneutropenia was 76.2%in PC group vs 48.6%in TC group (P=0.044). The most common cause for withdrawing from treatment was to be unable to tolerate the adverse effects. Conclusion:Adjuvant chemotherapy with paclitaxel and cyclophosphamide is safe, tolerable and promising for elderly breast cancer patients.

Human with bi-allelic WNT10A mutations and epithelial Wnt10a knockout mice present enlarged pulp chamber and apical displacement of the root furcation of multi-rooted teeth,known as taurodontism;thus,indicating the critical role of Wnt10a in tooth root morphogenesis.However,the endogenous mechanism by which epithelial Wnt10a regulates Hertwig's epithelial root sheath(HERS)cellular behaviors and contributes to root furcation patterning remains unclear.In this study,we found that HERS in the presumptive root furcating region failed to elongate at an appropriate horizontal level in K14-Cre;Wnt10afl/flmice from post-natal day 0.5(PN0.5)to PN4.5.EdU assays and immunofluorescent staining of cyclin D1 revealed significantly decreased proliferation activity of inner enamel epithelial(IEE)cells of HERS in K14-Cre;Wnt10afl/flmice at PN2.5 and PN3.5.Immunofluorescent staining of E-Cadherin and acetyl-α-Tubulin demonstrated that the IEE cells of HERS tended to divide perpendicularly to the horizontal plane,which impaired the horizontal extension of HERS in the presumptive root furcating region of K14-Cre;Wnt10afl/flmice.RNA-seq and immunofluorescence showed that the expressions of Jag1 and Notch2 were downregulated in IEE cells of HERS in K14-Cre;Wnt10afl/fl mice.Furthermore,after activation of Notch signaling in K14-Cre;Wnt10afl/flmolars by Notch2 adenovirus and kidney capsule grafts,the root furcation defect was partially rescued.Taken together,our study demonstrates that an epithelial Wnt10a-Notch signaling axis is crucial for modulating HERS cell proper proliferation and horizontal-oriented division during tooth root furcation morphogenesis.

Objective To investigate the impact of quercetin(Que)on postherpetic neuralgia(PHN)and chemokine ligand 3(CCL3,namely MIP-1α)/C-C chemokine receptor 1(CCR1)/C-C chemokine receptor 5(CCR5)signaling pathway in rats.Methods Sixty rats were divided into the control group(Con),the PHN group(model group),the L-Que(30 mg/kg)group,the M-Que(60 mg/kg)group,the H-Que(120 mg/kg)group and the H-Que+pathway activator MIP-1α(120 mg/kg Que+0.4 mg/kg recombinant MIP-1α)group.The mechanical paw withdrawal threshold(PWT)and thermal pain threshold(TWL)of rats were detected in each group.The kit was used to detect adenosine,Adenine ribonucleotide(AMP),adenosine diphosphate(ADP)and tumor necrosis factor in spinal dorsal horn samples-α(TNF-α),and interleukin-1 β(IL-1 β)levels in spinal dorsal horn samples.HE staining was applied to observe the pathological sections of spinal dorsal horn.Immunofluorescence staining was used to detect the activation of microglia in spinal dorsal horn.Western blot assay was applied to detect MIP-1α/CCR1/CCR5 signaling pathway protein expression.Results In the PHN group,the dorsal horn of the spinal cord was ruptured,the arrangement of nerve bundles was disordered,and inflammatory cell infiltration,edema,and slight atrophy of neurons appeared.Compared with the Con group,the PWT value,adenosine,AMP and ADP levels were obviously decreased in the PHN group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1-positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).After treatment with Que,the disordered arrangement of nerve bundles was improved,the infiltration of inflammatory cells was reduced,and the phenomenon of neuronal atrophy disappeared.Compared with the PHN group,the PWT value,adenosine,AMP and ADP levels were obviously increased in the L-Que group,the M-Que group and the H-Que group(P＜0.05).TWL value,TNF-αand IL-1β levels,the number of Iba1-positive microglia,and MIP-1α,CCR1 and CCR5 protein levels were obviously decreased(P＜0.05).The effect of Que was dose dependent.Compared with the H-Que group,PWT value,adenosine,AMP and ADP levels were obviously decreased in the H-Que+MIP-1α group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1 positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).Conclusion Que may reduce the inflammatory response in rats by inhibiting the MIP-1α/CCR1/CCR5 signaling pathway,thereby reducing PHN.

Objective To explore the clinical efficacy and toxicity of standard-dose IA regimen as induction chemotherapy in treating initially diagnosed acute myeloid leukemia (AML) patients ≥55 years old. Methods A total of 32 patients were enrolled in this study. The remission, survival time and adverse effects after IA regimen were retrospectively analyzed. Results The complete remission (CR) rate, partial remission (PR) rate and overall response (OR) rate were 71.9%(23/32), 9.4%(3/32), 81.3%(26/32) after IA regimen. In favorable, intermediate and poor prognosis groups (grouped by cytogenetic or molecular factors), 6, 14 and 3 cases achieved CR (χ2= 5.571, P= 0.067), 1, 2 and 0 cases achieved PR, while OR rates were 100.0 %(7/7), 84.2 % (16/19), 50.0 % (3/6) (χ2= 2.114, P= 0.359). The median overall survival (OS) time of three groups were 28.07 months (6.57-46.33 months), 16.93 months (0.40-87.57 months) and 3.03 months (2.00-6.00 months) (Z=9.630, P=0.008) and the 2-year OS rates were 83.33%, 46.80%and 0, respectively (χ2=12.206, P< 0.001). Myelosuppression and infections due to neutropenia were the main adverse effects and severe non-hemotologic toxicities were not observed. Conclusion The standard-dose IA regimen can increase CR/OR rate and prolong the median OS time of patients with favorable and intermediate prognosis and it can be used as the first induction chemotherapy regimen for elderly AML patients of ≥55 years old.