Objective To investigate the mechanism of unbalanced expressions of endothelin receptors (ETA/ETB )in cerebral vasospasm (CVS)after subarachnoid hemorrhage (SAH).Methods The rat CVS models were established by injecting autologous blood into the cisterna magna the second time.Basilar artery morphology was observed under light microscope and immunofluorescence staining was conducted to dynamically detect ETA/ETB receptor expression.Results The cross-sectional area of the basilar artery in the SAH model group decreased at 2 d to 3 d,and then gradually returned to normal.ETA receptor expression in endothelial cells of the basilar artery increased at 2 d after SAH,peaked at 3 d and remained increased till 14 d.ETB receptor expression increased significantly in endothelial cells at 3 d,peaked at 7 d and remained the same level till 14 d.Conclusion The results suggest that ETA/ETB receptors play an important role in cerebral vasospasm after SAH.The specific expression differences of ETB receptor subtypes in the brain vascular layers need further study.

Objective To study the dynamic expression and distribution of high mobility group box 1 (HMGB-1)in diffuse axonal injury (DAI)in rats and to clarify its involvement in the inflammatory reaction after DAI in rats,in order to provide new targets for the clinical treatment of DAI.Methods A DAI model was established using a coronal rotation device and evaluated by HE,Glees-Marsland silver staining,and Mallory phosphotungstic acid hematoxylin staining.Immunohistochemistry,Western blot and RT-PCR were used to detect the expression and distribution of HMGB-1 in the cortex of DAI rats at 6 h,1 d,3 d and 7 d.And TUNEL was used to examine the apoptosis of neurons in DAI rats.Results Immunohistochemical results showed that at 6 h and 1 d after DAI,the number of HMGB-1-positive cells decreased,but at 3 and 7 d it began to increase.Western blot also showed that during the early stage after DAI (6 h and 1 d),the level of HMGB-1 protein in the cortex was significantly lower than that in the control group,but at the late stage (3 and 7 d)after DAI it significantly increased compared with that in the control group until 7 d.RT-PCR showed that at 6 h after DAI there was no significant increase in the level of HMGB-1mRNA,but at 1 d there was a slight increase compared with the control group;at 3 and 7 d,it showed an obvious significance.TUNEL staining indicated that the significant neuronal apoptosis appeared as early as 6 h after DAI,and reached the peak at 3 d;it started to decrease at 7 d but still remained at a relatively high level.Conclusion The dynamic expression and distribution of HMGB-1 showed significant changes with the time course after DAI in rats.They decreased at the early stage but increased at the late stage.At the early stage, HMGB-1 is mainly passively released by the necrotic neurons,and at the late stage it may be actively secreted by the active inflammatory cells.HMGB-1 may mediate the post-DAI neural cell apoptosis by inducing the inflammatory reaction.

OBJECTIVETo investigate the clinicopathological features of gastric cancer in Southern China, and provide a base of research and therapy for gastric cancer.

METHODSA total of 1 879 cases of gastric cancer with radical gastrectomy from Southern China were collected from August 1994 to July 2012. Analyze and summarize the characters of gender, age, tumor location, WHO histopathologic type and grade, pTNM stage and family history, retrospectively.

RESULTSAmong all cases, male to female ratio was 2.08: 1, while female was more than male before 40 years (χ(2) = 77.831, P = 0.000). Cases aged over 60 years had a highest incidence of gastric cancer (46.0%), with predilection of sinus (45.7%), body (26.3%) and cardia (20.1%). The common WHO histopathologic types were tubular or papillary adenocarcinoma (81.5%) and signet ring cell carcinoma (11.0%). Most patients were at III or IV stage on pTNM staging (40.5% and 26.5%).

CONCLUSIONSGastric cancer in Southern China has a predilection on male, while female is more than male before 40 years. Gastric sinus and adenocarcinoma is most common. Most patients are diagnosed at advanced stages.

Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; epidemiology ; pathology ; Young Adult

OBJECTIVETo review the clinical features of duodenal gastrointestinal stromal tumors(GISTs), and to compare the clinical efficacy among different surgical treatments for duodenal GISTs.

METHODSClinicalpathological data of 36 cases of duodenal GISTs undergoing operation in The First Affiliated Hospital of Sun Yat-sen University from January 2000 to July 2013 were retrospectively analyzed. All the patients received surgical treatments, including 15 cases with regional resection, 8 cases with segmental resection, 12 cases with pancreaticoduodenectomy (PD), and 1 case with liver biopsy, respectively. Clinical efficacy between pancreaticoduodenectomy (PD) and non-PD (NPD) was compared.

RESULTSNine of 36 cases (25%) developed postoperative complications who were all in the PD group. Eight patients recovered and healed finally after active treatment, and 1 case was complicated with acute pancreatitis, pancreatic fistula and intra-abdominal infection. The median follow-up time was 54 months and the 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate were 78.1% and 72.1%, respectively. The 5-year OS rate in the PD group and the NPD group was 61.1% and 61.1% respectively. The 5-year RFS rate in the PD group and the NPD group was 85.8% and 78.8% respectively. Statistical analysis showed no significant difference between the both groups (P=0.71 and P=0.89).

CONCLUSIONSFor duodenal GISTs patients, regional resection and segmental resection have similar clinical outcomes to pancreaticoduodenectomy while the former two can obviously decrease the incidence of postoperative complications. Based on the premise of R0 resection guaranteed, regional sectional and segmental resection with less injury should be the surgical treatment of choice.

Duodenal Neoplasms ; Gastrointestinal Stromal Tumors ; Humans ; Intraabdominal Infections ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Postoperative Complications ; Retrospective Studies ; Survival Rate

Objective:To investigate the effect of Roy adaptation model-based intervention on fatigue and posttraumatic growth in patient with malignant lymphoma during chemotherapy.Methods:A total of 110 malignant lymphoma patients who undergoing chemotherapy were randomly divided into study group and control group, with 59 cases in each group. The control group received routine nursing method, the study group carried out Roy adaptation model-based intervention. The post-traumatic growth inventorynventory (PTGI) and the revised piper fatigue scale (PFS-R) was evaluated the effect of intervention, respectively.Results:Before and after chemotherapy, the new possibilities, relating to others, personal strength, appreciation of life, spiritual change and total PTGI scores were (8.90±1.00), (17.27±3.66), (15.11±2.63), (15.23±4.19), (4.16±0.87), (60.45±6.49) and (9.64±1.38), (21.49±4.43), (17.78±4.17), (19.31±5.82), (4.95±0.89), (73.16±8.85), in addition, those index scores in the control group were [(8.74±1.40), (17.13±3.86), (15.46±3.55), (15.80±2.81), (4.26±1.15), (61.43±6.93) and (9.14±1.86), (18.44±4.31), (16.34±2.77), (17.97±3.18), (4.74±1.07), (66.63±6.68)]. There was no significant difference in PTGI scores between study group and control group ( P>0.05), however, relating to others, personal strength and total PTGI scores were significantly increased in the study group compared to the control group ( P<0.05). Before and after chemotherapy, the sensory, emotional, knowledge, behavioral and total PFS-R scores were (5.68±0.82), (4.80±1.06), (4.27±0.81), (4.16±0.47), (5.05±0.74) and (2.43±0.73), (4.27±0.61), (2.44±0.45), (4.07±0.73), (3.89±0.77), in addition, those index scores in the control group were [(5.73±1.23), (4.85±0.64), (4.37±0.74), (4.17±0.38), (4.98±0.82) and (4.48±0.72), (4.90±0.75), (3.45±0.53), (4.23±0.81), (4.60±0.57)]. There was no significant difference in PFS-R scores between study group and control group ( P>0.05), however, sensory, emotional, knowledge and total PFS-R scores were significantly decreased in the study group compared to the control group ( P<0.05). Conclusion:Roy adaptation model-based intervention can effectively alleviate fatigue and promote post-traumatic growth in patient with malignant lymphoma during chemotherapy.

OBJECTIVETo establish subcutaneous xenograft models of gastric cancer in nude mice and to screen the predictive biomarkers of bevacizumab effectiveness.

METHODSSubcutaneous xenograft models were established using BGC823 gastric cancer cell line in 20 male 4-week old BALB/C-nu/nu nude mice and were randomly divided into four groups, bevacizumab group(15 mg/kg), 5-FU group(15 mg/kg), combined group and control group, with 5 mice in each group. Bevacizumab and 5-FU were administered intraperitoneally every other day for three weeks. After treatment, tumor size and inhibition rate were calculated. Expression of CD31 was examined by immunohistochemistry for evaluation of microvascular density(MVD). Levels of human vascular endothelial growth factor(VEGF), basic fibroblast growth factor (bFGF), placental growth factor (PIGF) and interleukin 8(IL-8) were tested by enzyme linked immunosorbent assay(ELISA).

RESULTSCompared to the control group, bevacizumab group and combined group had a significantly lower MVD(5.2±1.0 and 4.3±1.2 vs. 13.8±1.6, P<0.05), a smaller tumor volume [(305.6±184.1) mm(3) and (242.2±71.4) mm(3) vs.(1535.2±625.1) mm(3), P<0.05], and lower levels of VEGF and IL-8 in tumor tissues [VEGF:(351.6±84.1) ng/L and (242.2±71.4) ng/L vs. (1256.7±702.1) ng/L, P<0.05); IL-8:(20 903±1485) ng/L and (27 489±6772) ng/L vs. (57 032±2437) ng/L, P<0.05]. The above parameters were not significantly different between 5-FU group and control group(all P>0.05). Levels of bFGF and IGF were not significantly different among four groups as well(all P>0.05).

CONCLUSIONVEGF and IL-8 may be used to be biomarkers candidates to predict bevacizumab effectiveness on human gastric cancer.

Animals ; Antibodies, Monoclonal, Humanized ; Bevacizumab ; Biomarkers ; Cell Line, Tumor ; Fluorouracil ; Heterografts ; Humans ; Immunohistochemistry ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Stomach Neoplasms ; Vascular Endothelial Growth Factor A ; Xenograft Model Antitumor Assays

Objective To investigate the role of AMP-activated protein kinase (AMPK) signal path in cell autophagy activation at early brain injury in rats after subarachnoid hemorrhage (SAH).Methods Adult male SD rats (weighting 300-350 g) were divided into five groups (n=12):sham-operated group,SAH group,and SAH+AICAR group,SAH+Compound C group and SAH+vehicle group.SAH models in the later four groups were established by endovascular perforation technique,and rats in the later three groups were performed left intracerebroventricular injection of AMPK agonist AICAR,AMPK inhibitor Compound C or normal saline 30 min before modeling;animals were subsequently sacrificed at 24 h after modeling.Immunohistochemical method was used to detect the phosphorylated mammalian target of rapamycin (p-mTOR) expression.Expressions of cortex autophagy related proteins LC3,AMPK and phosphorylated AMPK (p-AMPK) were observed by Western blotting.Loeffler's method was used to evaluate the neurologic behavior scores.Results As compared with those in the sham-operated group,the p-AMPK level,p-mTOR expression level and LC3Ⅱ/LC3Ⅰ ratio were significantly increased,while the behavioral deficit scores were significantly lower in the SAH group,with statistical differences (P＜0.05);the p-mTOR mainly expressed at cortex surrounding the hemorrhage areas,and integration areas of deep cortex and brain white matter.As compared with the sham-operated group and SAH+vehicle group,SAH+AICAR group had significantly increased p-AMPK level,decreased p-mTOR expression level,increased LC3Ⅱ/LC3Ⅰ ratio,and decreased behavioral deficit scores (P＜0.05);as compared with the sham-operated group and SAH+vehicle group,SAH+Compound C group had significantly decreased p-AMPK level,decreased LC3Ⅱ/LC3Ⅰ ratio,and decreased behavioral deficit scores (P＜0.05).Conclusion AMPK is involved in the process ofautophagy activation after SAH through regulating mTOR,and the regulation of AMPK may contribute to neuroprotection related to autophagy.

Diabetic retinopathy （DR） is one of the most common chronic microvascular complications of diabetes mellitus. It has a high rate of blindness， and the age of onset is gradually getting younger， which seriously affects the physical and mental health and quality of life of patients. The disease is retinal damage induced by diabetes mellitus， which is a kind of fundus disease with the main manifestations of fundus hemorrhage， hard exudation， microhemangioma， cotton-wool spots， neovascularization， etc. In traditional Chinese medicine （TCM）， it is classified into the category of "diabetic cataracts" and other diseases. At present， there is no effective method to prevent the progress of the disease in modern medicine， so it is particularly important to choose a reasonable and effective intervention to prevent and treat DR. Studies have confirmed that TCM has unique advantages in the treatment of DR. It can use its advantages of multiple bioactive components， multiple targets， and multiple pathways to intervene in the development process of DR from various aspects. By searching for the relevant literature on the progress of the intervention of DR with TCM monomers and compounds， this paper mainly reviews the relevant research results of the treatment of DR with multiple signaling pathways such as phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， nuclear factor kappa-B（NF-κB）， p38 mitogen-activated protein kinase （p38 MAPK）， nuclear factor erythroid 2-related factor （Nrf2）/hemeoxygenase-1 （HO-1）， Hippo， advanced glycation end products （AGEs）/receptor for advanced glycation end products （RAGE）， and Akt/glycogen synthase kinase-3β （GSK-3β）， so as to provide more ideas and directions for the clinical prevention and treatment of DR.

As a threat to human health， steroid-induced osteonecrosis of femur head is a common refractory orthopedic disease mainly caused by glucocorticoids， with poor prognosis and unclear pathogenesis. Osteogenesis-associated signaling pathways play an important role in bone formation. Glucocorticoid-induced abnormal activation and transport of these signaling pathways lead to abnormal differentiation of bone marrow mesenchymal stem cells， dysfunction of bone metabolism， and osteogenesis disorders， which may be the main reasons for the occurrence and development of steroid-induced osteonecrosis of femur head. Bone formation and remodeling need the participation of bone marrow mesenchymal stem cells， which are stem cells characterized by continuous self-renewal and differentiation. The key to strengthening bone remodeling is to improve the osteogenic differentiation capacity， which is the key point to inhibit bone resorption and prevent bone marrow mesenchymal stem cells from differentiating into osteoclasts. Traditional Chinese medicine （TCM） has been used in the treatment of osteonecrosis in ancient times. It is recorded in the Treasury of Words on Materia Medica （《本草汇编》） that "The deficiency in the lower energizer cannot be tonified without Eucommiae Cortexz.The soreness in lower legs cannot be alleviated without Eucommiae Cortex...The pain in the waist and knee cannot be relieved without Eucommiae Cortex...Tonifying liver and invigorating kidney， Eucommiae Cortex is an essential medicine." This indicates that ancient physicians have already begun to use the liver-tonifying， kidney-invigorating， and sinew-bone-strengthening effects of Eucommiae Cortex for the treatment of osteonecrosis. As the national support for the development of TCM strengthens， increasing studies have been conducted on the TCM prevention and treatment of steroid-induced osteonecrosis of femur head. Studies have suggested that Chinese medicinal herbs can exert a positive effect on the differentiation of bone marrow mesenchymal stem cells by affecting targeted signaling molecules， and promote osteogenesis and bone defect repair， thus combating the occurrence and development of steroid-induced osteonecrosis of femur head. The regulation of osteogenic signaling pathway by Chinese medicines to prevent steroid-induced osteonecrosis of femoral head has become a hot research topic. This article reviews the studies about the prevention and treatment of steroid-induced osteonecrosis of femur head with the active components in Chinese medicinal herbs by regulating osteogenic signaling pathways. We then explore the mechanism of the active components in promoting the differentiation of bone marrow mesenchymal stem cells into osteoblasts and inhibiting their differentiation into osteoclasts to facilitate bone formation， aiming to provide a reference for the further study of treating steroid-induced osteonecrosis of femoral head with Chinese medicinal herbs.

BACKGROUNDAs a common form of gastric cancer migration, lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer. Surgery is the fundamental curative option for gastric cancer that varies depending on different stages. The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.

METHODSIn our retrospective study, the data of 328 patients of proximal gastric cancer with different T stages were analyzed. By comparing the differences of lymph node metastatic rate and ratio, we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes. Also, we were especially interested in the differences in survival rates between patients with and without No. 5 and 6 group metastasis with the same TNM stage.

RESULTSThe overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4% and 23.3%, respectively. The tumors of different T stages were statistically significant in size and differentiation degree (P < 0.05), multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer (RR, 12.025; 95% CI, 2.326 to 62.157; P = 0.003). The overall survival rate of patients with No. 5, 6 group lymph node metastasis and those without was significantly different, but the differences in survival rates between patients with and without No. 5 and 6 group metastasis with the same TNM stage were not statistically significant.

CONCLUSIONSDifferent T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis. D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare. Therefore the range of the lymph node dissection in radical gastrectomy for early gastric cancer was considered reasonable. Moreover, to meet the requirements of the lymph node dissection, total gastrectomy plus D2 lymphadenectomy or more are supposed to be applied for the advanced proximal gastric cancer patients. Precise T staging largely determines the range of gastrectomy and lymphadenectomy.

Aged ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery