Objective In order to cure some patients with the following characteristics which appear only when smiling: elevation and shortening of the upper lip, a transverse furrow below the co-lumella, and increased exposure of the maxillary gums, we reported a new surgical procedure to cor-rect this deformities. Methods By means of a transfixion incision extended laterally along the vestibu-lar or the upper gingivolabial sulcus incision, part of the depressor septi and orbicularis muscle were excised, and extensive separation were made to lower the upper lip. Results 27 cases of short upper lip were treated. Among the total, the transfixion incisions were made in 9 cases, and the upper gingi-volabial sulcus incisions were made in 18 cases. These procedures achieved lowering the upper lip, lighting or disappearing the transverse furrow, and covering the exaggerated exposure of the gums when patients smiled. At the same time the rhinoplasties were done in 6 cases. Through the above-mentioned we were able to correct the deformities on rhino-gingivolabial part only when the faces moved, achieved some kind of beauty for patients, and obtained satisfactory results. Conclusions Some patients have added defects .that are exported only when they begin to make facial movements. The cause of these characteristics is hypertrophy of the depressor septi nasi muscles. We describe the technique that is not only to correct the defects but also to enhance the patient's smile. It is worth to recommend for clinical application.

Objective:To investigate the effect of electroacupuncture (EA) at Ganshu (BL 18) and Shenshu (BL 23) on vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1)/CD31 around the cerebral infarction focus in middle cerebral artery occlusion (MCAO) rats and the possible mechanism, thus to provide a new strategy for the treatment of cerebral ischemic stroke by acupuncture. Methods:A total of 180 healthy male Sprague-Dawley (SD) rats were randomly divided into a sham operation group, a model group, an acupoint group and a non-acupoint group, 45 rats in each group. MCAO model was established using the modified line-embolus method in all rats except for those in the sham operation group; rats in the acupoint group were treated with EA at Ganshu (BL 18) and Shenshu (BL 23); rats in the non-acupoint group were treated with EA at the control points; rats in other 2 groups were only subjected to bundling without treatment. Ten rats in each group were randomly selected on the 3rd day, the 14th day and the 21st day after acupuncture stimulation to test the neurological function impairment. The expression levels of CD31 and VEGF were also detected. Results:Compared with the model group and non-acupoint group, the neurological function score of the acupoint group was decreased at each time point, and the differences were statistically significant (P<0.05,P<0.01). The expressions of VEGF and CD31 in each group were the lowest on the 3rd day, reached the peak on the 14th day and still remained at high level on the 21st day. And the differences among groups were statistically significant both on the 14th day and the 21st day (P<0.05,P<0.01). Compared with the model group and the non-acupoint group, the expressions of VEGF and CD31 in the acupoint group were increased, and the differences were statistically significant (allP<0.05). Conclusion: EA at Ganshu (BL 18) and Shenshu (BL 23) can significantly improve the neurological function score of MCAO model rats, and shows protective effect on cerebral ischemia. The protective mechanism may be related to the up-regulation of CD31 and VEGF expression around the cerebral infarction focus in the MCAO model rats and induction of angiogenesis.

BACKGROUND: Proximal femoral nail anti-rotation is widely used to treat various intertrochanteric fractures. Although its operation trauma is small, and the blood loss of perioperative period is still large. Tranexamic acid has been gradually used to reduce the bleeding of intertrochanteric fracture. The effectiveness and safety of reducing blood loss during perioperative period were not reported. OBJECTIVE: To explore the safety and efficacy of tranexamic acid on perioperative blood loss in patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation. METHODS: One hundred and eight patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation were selected from First Affiliated Hospital, Guangzhou University of Chinese Medicine between January 2015 and January 2017. Among all the subjects, 52 patients who received the operation before January 2016 served as the control group and 56 patients who received the operation after January 2016 were selected as the treatment group. Half an hour before operation, patients in the treatment group received 1 g tranexamic acid dissolved in 250 mL normal saline by intravenous dropping; patients in the control group just received 250 mL normal saline by intravenous dropping. The bleeding volume, blood transfusion volume, hemoglobin, hematocrit, coagulation index, D-dimer levels and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) During perioperative period, actual blood loss, intraoperative blood loss, dominant blood loss, recessive blood loss, volume of drainage, blood transfusion volume and blood transfusion rate were lower in the treatment group than in the control group (P < 0.05). (2) There was no statistically significant difference in the hemoglobin and hematocrit between the two groups before operation (P > 0.05). The hemoglobin and hematocrit of the two groups gradually decreased after the operation, and there was a slight improvement in the fifth day after surgery. At postoperative 2 hours, 1, 3 and 5 days, the hemoglobin and hematocrit of the treatment group were higher than in the control group (P < 0.05). At preoperation and each time point postoperation, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not statistically significant between the two groups (P > 0.05). Postoperative D-dimer levels in the two groups were significantly higher than preoperation, and there was a return on the fifth day. There was no statistically significant difference between groups at preoperation and each time point of postoperation (P > 0.05). (3) The results suggest that the tranexamic acid can effectively reduce the dominant and recessive blood loss in patients with the intertrochanteric fracture, and it is safe and effective.

The aim of this study was to investigate the relationship between the plasma levels of chemokine CCL-2/MCP-1 and acute graft-versus-host disease (aGVHD) and/or idiopathic pneumonia syndrome (IPS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). ELISA assays were used to detect the plasma level of CCL-2/MCP-1 of 22 patients who received allo-HSCT, including 14 patients without or with grade I, 8 patients with grade II - IV aGVHD, respectively. 8 out of 22 patients were also diagnosed with IPS clinically. The dynamic changes of the plasma levels of CCL-2/MCP-1 chemokine and its correlation with aGVHD and/or IPS were analysized retrospectively. The results showed that the plasma levels of CCL-2/MCP-1 in the patients with moderate and serious aGVHD (grade II - IV) significantly increased, as compared with that prior to allo-HSCT (p < 0.05). The plasma levels of CCL-2/MCP-1 in the patients with aGVHD and/or IPS were higher significantly than those without any of these complications (p = 0.001). The retrospective analysis indicated that the plasma levels of CCL-2/MCP-1 in the patients with IPS significantly increased (p = 0.006). It is concluded that plasma level of CCL-2/MCP-1 correlates with aGVHD and/or IPS, and plays a role in the pathogenesis of these complications.
Adolescent ; Adult ; Chemokine CCL2 ; blood ; Child ; Child, Preschool ; Female ; Graft vs Host Disease ; blood ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Lung Diseases, Interstitial ; blood ; etiology ; Male ; Middle Aged ; Syndrome ; Young Adult

BACKGROUNDHypertension often persists after adrenalectomy for primary aldosteronism (PA). Many studies have analyzed the outcomes of adrenalectomy for aldosterone-producing adenomas (APA) to identify predictive factors for persistent hypertension. However, differentially expressed genes in persistent postoperative hypertension remain unknown. Our aim was to describe gene expression profile of persistent postoperative hypertension patients with APA.

METHODSIn this study, we described and compared gene expression profiles in persistent postoperative hypertension and postoperative normotension in Chinese patients with APA using microarray analysis. Confirmation was performed with quantitative real time-polymerase chain reaction analysis. Bioinformatic analysis (gene ontology analysis, pathway analysis and network analysis) was used for further research.

RESULTSMicroarray analysis identified a total of 99 differentially expressed genes, including 18 up-regulated and 81 down-regulated genes. Among the dysregulated genes were fat atypical cadherin 1 as well as fatty acid binding protein 4 and other genes that have not been previously studied in persistent postoperative hypertension with APA. Bioinformatics analysis indicated that differentially expressed genes were associated with lipid metabolic process, metal ion binding, and cell differentiation. Pathway analysis determined that five pathways corresponded to the dysregulated transcripts. The mRNAs-ncRNAs co-expression network was composed of 49 network nodes and 72 connections between 18 coding genes and 31 noncoding genes.

CONCLUSIONSThis study revealed differentially expressed genes in persistent postoperative hypertension with APA and provided a resource of candidate genes for exploration of possible drug targets and prognostic markers.

Adenoma ; metabolism ; physiopathology ; surgery ; Adrenalectomy ; Aldosterone ; metabolism ; Blood Pressure ; physiology ; Gene Expression Profiling ; methods ; Humans ; Hyperaldosteronism ; metabolism ; physiopathology ; surgery ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo develop a new imaging agent, (99m)Tc-Rituximab, for sentinel lymphoscinti-graphy and investigate its feasibility in detecting the sentinel lymph node (SLN) for breast cancer patient.

METHODS(99m)Tc-Rituximab was prepared by introducing (99m)Tc directly into the mclecule of Rituximab, thus a new kind of lymphoscintigraphy agent ((99m)Tc-Rituximab) was produced. Five Bal b/c mice and ten breast cancer patients underwent dynamic SLN mapping procedures using (99m)Tc-Rituximab. Axillary lymph node status in breast cancer patients were evaluated with the fusion images, which was processed by computer software. With ROI technique, SLN/background ratio and the rate of SLN uptake were calculated and the dynamic curve of SLN uptake was drawn. The other 61 breast carcinoma patients underwent routine lymphatic mapping. Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) were both performed in all 71 patients. Fresh SLNs and all axillary nodes were sent for pathological examination using hematoxylin and eosin (H&E) staining.

RESULTS(99m)Tc-Rituximab, with a yield of about 95.0%, can show SLN status in both mice and patients. The fusion image showed SLNs clearly, even the depth of SLNs in the axilla. The results of dynamic SLN mapping showed visible SLN starting from 10 min, up to 16 h after injecting tracer, however, secondary lymph nodes were not detectable at all. In mice, the ratio of SLN/background was 2.1, the rate of uptake was about 3.0% to 3.5%, and the equation of the curve was produced as: y = 0.036x + 2.7875, r(2) = 0.9787. For breast cancer patients, the uptake rate was different from case to case, but the cure seemed to be consistent with logarithm. The result of SLNB and ALND showed that the sensitivity and accuracy of SLNB was both 100.0%. The average number of SLNs found in each case was 2.6. Of nineteen breast cancer patients (26.8%) with lymph node metastasis, 11 were found to only have SLN metastasis.

CONCLUSION(99m)Tc-Rituximab, as a new tracer to mapping sentinel lymph node for breast cancer patient, is able to show the status of sentinel lymph node reliably. The fusing image is easy to obtain and be interpreted by the clinician.

Adult ; Aged ; Animals ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Axilla ; Breast Neoplasms ; diagnostic imaging ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; pathology ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Mice ; Mice, Inbred BALB C ; Middle Aged ; Organotechnetium Compounds ; Radionuclide Imaging ; Random Allocation ; Sentinel Lymph Node Biopsy ; methods

OBJECTIVETo study the feasibility and effects of new imaging agent, 99mTc-Rituximab, for sentinel lymph nodes biopsy (SLNB) of primary breast cancer.

METHODSSLNB were performed in eighty-five primary breast cancer patients using 99mTc-Rituximab combined with patent blue. Metastases in sentinel lymph nodes were detected with routine pathologic and immunohistochemistry method.

RESULTSThe successful rate of SLNB using combining method of 99mTc-Rituximab and patent blue was 96% (82/85). Thirty cases of SLN (37%, 30/82) were metastasis positive, including twenty-four positive cases by HE staining and six by immunohistochemistry method. SLN was the only metastasis lymph nodes in 18/30 cases. One case has false negative SLN metastasis. The sensitivity and accuracy of SLNB were 97% (30/31) and 99% (81/82). The specificity was 100% (51/51). The false negative rate was 3% (1/30) and the negative predictive value was 98% (51/52). The positive predictive value was 100% (31/31). Internal mammary sentinel lymph node lymphoscintigraphy was positive in eleven cases but all of them were confirmed metastases negative by pathologic examination.

CONCLUSIONS99mTc-Rituximab, as a new imaging agent, can keep SLN imaging durable and can make SLNB more convenient. Through primary clinical manifestation, higher sensitivity and accuracy could obtained by combining method of 99mTc-Rituximab and patent blue for SLNB of primary breast cancer.

Adult ; Aged ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Breast Neoplasms ; pathology ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Rituximab ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; methods ; Technetium

OBJECTIVETo evaluate the clinical efficacy of Jianpi Liqi Yiliu Formula (JLYF) combined with cytokine-induced killer (CIK) cells for treating patients with advanced hepatocellular carcinoma (HCC).

METHODSBetween January 2011 and January 2014, 60 advanced HCC patients were enrolled in this study, who were assigned to the treatment group and the control group according to their willingness for taking JLYF, 30 cases in each group. All patients received CIK cell treatment: 1 x 10⁹-3 x 10⁹ each time, by intravenous dripping from the 1st day to the 3rd day, once per day. Besides, patients in the treatment group took JLYF decoction, while those in the control group took Chinese medical decoction by syndrome typing. All patients received treatment of at least two cycles. The time to progression (TTP) , overall survival (OS), disease control rate (DCR), performance status scale (PS), Child-Pugh scale, and adverse reactions were observed, and subgroup analyzed.

RESULTSTo May 31, 2014, all patients reached the clinical endpoint. TTP was 3.5 months (95% Cl: 3.30-4.10) in the treatment group, better than that (2.5 months, 95% CI: 2.32-2.68) of the control group (P < 0.05). DCR was 36.7% in the treatment group and 30.0% in the control group (P > 0.05). OS was 5.2 months (95% CI: 4.53-5.87) in the treatment group and 4.6 months (95% CI: 4.06-5.14) in the control group (P > 0.05). The PS scale was 1.60 ± 0.10 after treatment, lower than that (1.80 ± 0.09) before treatment in the treatment group (P < 0.05). When the PS scale was 0-2 or Child-Pugh scale was class A, TTP was longer in the treatment group than in the control group (P < 0.05). No adverse reaction occurred in the two groups during the treatment course.

CONCLUSIONSThe combination of JLYF with ClK cell treatment could prolong advanced HCC patients' TTP, improve PS scale, as compared with syndrome typed Chinese medical decoction treatment group. Besides, when the PS scale was 0-2 or Child-Pugh scale was class A, it was a better treatment program for advanced HCC patients.

Carcinoma, Hepatocellular ; therapy ; Cell- and Tissue-Based Therapy ; Cytokine-Induced Killer Cells ; cytology ; Disease Progression ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Liver Neoplasms ; therapy

Visci Herba， a commonly used Chinese medicinal， was often mistaken as Taxilli Herba in ancient Chinese materia medica. The two Chinese medicinals have often been confused even in present clinical practice， and their origins are difficult to be identified. Hence， it is necessary to carry out systematic and in-depth textual research. This paper explored the origin， producing area， quality evaluation， harvesting and processing， property， flavor， and efficacy of Visci Herba based on ancient Chinese materia medica of the past dynasties and modern plant morphology， so as to provide evidence for the development and utilization of Visci Herba. The findings demonstrated that Visci Herba was mostly recorded as Taxilli Herba until the name of Visci Herba appeared in the Tang Dynasty. The records of the two Chinese medicinals could be traced back to the Song Dynasty. Visci Herba and Taxilli Herba were officially listed as two different Chinese medicinals in the 1977 edition Chinese Pharmacopoeia for the first time， where the origin of Visci Herba was determined to be Viscum coloratum（Komar.）Nakai. According to the ancient Chinese materia medica， V. coloratum was mainly distributed in Lingbao， Henan province and Xuzhou， Jiangsu province and now it mostly grows in Northeast China and North China. In ancient times， Visci Herba with deep yellow cross-section and sticky fruit juice on the tree was preferred， which was often harvested on 3， March in spring， dried in the shade， grinded together with the roots， branches， stems， and leaves using the copper file， and preserved away from fire. By contrast， it is now usually harvested from winter to the next spring and then cut into sections for drying after the removal of thick stems， or dried after being steamed. As described in ancient Chinese materia medica， Visci Herba， bitter and sweet in flavor， neutral in property， possessed the effects of dispelling rheumatism， tonifying kidney， strengthening sinews and bones， benefiting blood vessels， and preventing abortion， basically consistent with its modern functions of dispelling rheumatism， tonifying liver and kidney， strengthening sinews and bones， and preventing abortion.

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.
Adalimumab ; Asia ; Asian Continental Ancestry Group ; Biological Factors ; Biosimilar Pharmaceuticals ; Colitis ; Colitis, Ulcerative ; Consensus ; Cooperative Behavior ; Crohn Disease ; Gastroenterology ; Hepatitis B ; Humans ; Immunologic Factors ; Inflammatory Bowel Diseases ; Infliximab ; Pharmacogenetics ; Philippines ; Practice Guidelines as Topic ; Tuberculosis ; Ulcer