[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Objective To explore the influence of no drainage on pelvic lymphocyst following laparoscopic radical hysterectomy and pelvic lymphadenectomy . Methods A total of 105 patients with cervical cancer undergoing laparoscopic radical hysterectomy and pelvic lymphadenectomy in this hospital from January 2012 to February 2016 were divided into either non-drainage group (50 cases) or drainage group (55 cases) according to whether the pelvic drainage tube was placed after surgery .Comparative analyses on the incidence of postoperative complications such as pelvic lymphocyst were made between the two groups . Results No significant difference in lymphocyst rate was found between the two groups [27.3%(15/55) vs.24.0%(12/50), χ2 =0.147, P=0.702].The incidence of pelvic infection was lower in the non-drainage group (2.0%, 1/50) than that in the drainage group (14.5%, 8/55), but the difference was not statistically significant (χ2 =3.781, P=0.052).Other postoperative complications including urinary retention , urinary fistula, and deep venous thrombosis of lower limb had no statistical differences between the two groups (P>0.05). Conclusions Drainage after radical hysterectomy and pelvic lymphadenectomy for cervical cancer does not make a difference to the incidence of lymphocyst .Non-drainaging doesn ’ t increase the risk of infection .

Background Epipolis laser in situ keratomihusis(Epi-LASIK) is an potential surgery for myopia because it synthesize advantages of LASEK and LASIK. But its clinical effectiveness and safeness is remarkable.Objective This study was to evaluate the clinical curative effects and safeness of Epi-LASIK for myopia in different diopter of population. Methods Retrospective study was designed for 208 eyes of 104 patients who underwent EpiLASIK for the correction of myopia. The patients were divided into two groups according to preoperative diopter:lower myopia group( ≤ -6.00 D, 111 eyes) and high myopia group ( ＞-6.00 D,97 eyes). The time of epithelial healing, postoperative syndrome, postoperative visual acuity, refraction, intraocular pressure (IOP) , the safe index, the efficacy index and haze were evaluated at 1,3,6,12 months postoperatively. The written informed consent was obtained from each individual before surgery. Results After operation, 20 eyes ( 18.02% ) of lower myopia group and 29 eyes (29.90%) of high myopia group had obvious pain, presenting statistically significant difference between two groups (X2 = 4. 060, P＜0.05 ). The mean time of epithelial healing was (5.49±0. 83 )days in lower myopia group and (5.85± 0.68 )days in high myopia group with a delayed epithelial healing time in high myopia group( u= 3. 377 ,P＜0.05 ).One year after the treatment,the uncorrected visual acuity( UCVA ) ≥ 1. 0 was 90. 99% ( 101 eyes) in lower myopia group and 75.26% ( 73 eyes) in high myopia group, and 9.91% ( 11 eyes) and 15.46% ( 16 eyes) of the eyes improved byl line or more in best spectacle corrected visual acuity(BCVA) ;whereas 3.60% (4 eyes)and 6. 18% (6 eyes)lost a line or more. 91.89% ( 102 eyes) and 85.57% (83 eyes) in both groups gained within 1.00 D of the attempted correction. The safety index and efficacy index were 1.04 and 0. 98 in lower myopia group,and 1. 01 and 0. 96 in high myopia group without statistically significant difference( P＞0. 05 ). haze occurred in 6 eyes in lower myopia group and 9 eyes in high myopia group and the difference in haze grading was not statistically significant between two groups ( P＞0. 05 ). The high intraocular pressure appeared in 10 eyes and 9 eyes in low myopia group and high myopia group respectively during the fellow up duration and back to normal after topical use of timolol. Conclusion Epi-LASIK is an effective and safe method for correction of different diopters of myopia because of its mild symptom and lower incidence of haze.

Triple-negative breast cancer (TNBC) is a subtype of breast cancer known for the poor prognosis due to its strong invasiveness, high recurrence rate, and lack of effective treatment. Therefore, there is an urgent need to find targeted therapy for TNBC. Cathepsin A (CTSA) is an acidic serine carboxypeptidase that is highly expressed in various tumor tissues. However, the role and molecular mechanism of CTSA in TNBC are still unclear. This study found that the expression of CTSA was upregulated, and the high expression of CTSA was positively correlated with the poor prognosis of TNBC. The results further showed that knocking down CTSA inhibited the proliferation, invasion, and colony formation of TNBC cells, improved drug sensitivity of cells, and inhibited the progression of TNBC. Mechanistically, CTSA inhibited the ubiquitination and degradation of the promyelocytic leukemia protein (PML) protein by blocking the interaction between PML and its E3 ubiquitin ligase RNF4, thus maintaining the stability of PML nuclear bodies (PML-NBs). The inhibitor of CTSA had a positive therapeutic effect on inhibiting the characteristics of TNBC stem cells. In conclusion, this study demonstrates that inhibiting CTSA to decrease the stability of PML protein may be a promising therapeutic strategy for TNBC. All animal experiments in this experiment were approved by the Ethics Committee of Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College (approval number: IMB-20240326D502).

AIM: To observe the effect of angiotensinⅡ subtype 2 receptor (AT_2 receptor) on the cultured rat aortic vascular smooth muscle cells. METHODS: The plasmid contained the cDNA of AT_2 receptor was transfected into cultured rat vascular smooth muscle cells. The effects of AngⅡ, Ang Ⅱ+losartan, Ang Ⅱ+PD123319 on the expression of PCNA, the NOS activity and the cell number were observed. RESULTS: The cell number and the expression of PCNA decreased after the cells were treated with losartan. When treated with PD123319, the cell number and the expression of PCNA increased, but the expression of NOS decreased. CONCLUSIONS: These data suggest that when being activated, AT_2 receptor inhibits the proliferation of vascular smooth muscle cells and antagonizes the effect of AT_1 receptor, such an effect may be related to the activation of NOS. [

Objective To evaluate the effect of the lactate clearance rate as a guide of the fluid resuscitation in multiple trauma patients with hemorrhage shock .Methods Sixty‐three multiple trauma patients with hemorrhage shock were divided into two groups ,which were group A (32 patients) and group B (31 patients) .In group A ,the central venous pressure (CVP) between8 and 12 mm Hg ,and the mean arterial pressure (MAP) (65 ± 5) mm Hg served as the goals of the fluid resuscitation .The B group ap‐plied the same goals of the CVP and MAP as group A .In addition ,the calculated lactate clearance rate (≥10% ) was used as the treatment target .The percent of patients reaching resuscitation goals and the ratio of the lactate clearance rate (≥10% ) at 2 hours after surgery ,the volume difference of infusion during the first 24 hours ,the incidences of organ dysfunction ,and the average days in ICU were compared between the two groups .Results The percent of patients reaching resuscitation goals at 2 hours after sur‐gery of group A was significantly higher than that of group B(P<0 .01) .The volume of the infusion of 24 hours in group A was less than that in group B(P< 0 .01) .There was no difference in the percent of patients reaching the lactate clearance rate at 24 hours after surgery(≥10% )and the infusin of red blood cells and plasma volume at 24 hours after surgery between the two groups (P>0 .05) .The incidence of organ dysfunction of group A was higher than that of group B (P<0 .05) .The average days in ICU of group A were longer than that of group B(P<0 .01) .Conclusion Based on monitoring CVP and MAP ,fluid resuscitation under the guidance of the lactate clearance rate(≥10% )may decrease the incidences of organ dysfunction and the days of patients in ICU .

Objective The effect of electronic cigarettes (e-cigarettes) on smoking reduction,cessation and human health remains controversial,meanwhile,studies tocused on e-cigarettes are limited.We conducted this meta-analysis in purpose of helping figuring out the controversy.Methods PubMed, Medline,Embase,Cochrane library,CNKl and Wanfang Databases were searched for articles published up to May 2014.All studies discussing the relationship between e-cigarettes and smoking reduction,smoking cessation or human health were included.The fixed or random-eftect model was used to pool the relative risk(RR).Outcome 4 articles were included based on the inclusion and exclusion criteria,there were totally 7 002 subjects.Meta-analysis indicated that there was significant difference in e-cigarettes and smoking reduction,RR=1.88,95％ CI:1.07-3.32,P=0.09.The Meta-analysis showed that e-cigarettes were available in smoking cessation.RR=1.55,95％ CI:1.24-1.95,P=0.001.Conclusion Tiffs meta-analysis indicated that e-cigarettes were helpful in smoking cessation.Nonetheless,the articles included were too few to credibly support the outcome.Hence,more high-quality,randomized blind and large sample experiments are needed to verify the results.

The outcome of spinal cord injury is related to many factors, such as mechanism and severity of injury, and differences of individual. The standard of clinical trial plays a very important role in the reliability of the research. especially the inclusion and exclusion criterias, ethical issues, treatment standardization, informed consent and other issues. The effect of these factors on the clinical trial of spinal cord injury was summarized in this article. The inclusion and exclusion criterias to control the consistency should be developed based on the specific research content. Informed consent for clinical trial is also necessary, especially to the clinical trials with uncertainly benefits and risks, as well as the standardization of the operation procedures and rehabilitation treatment.

Objective To explore the surgical technique and analyze the clinical efficacy of tubular stomach reconstruction via the posterior mediastinal approach after Iovr-Lewis radical resection of esophageal cancer.Methods The clinical data of 63 patients with middle-lower esophageal cancer who were admitted to the First People's Hospital of Chengdu between April 2013 and April 2015 were retrospectively analyzed.All the patients underwent Iovr-Lewis radical resection of esophageal cancer and tubular stomach reconstruction via the posterior mediastinal approach.Video-assisted minithoracotomy (VAMT) was used for anastomosis of esophagus-gastric tube at the top of thorax after laparoscopic abdominal surgery, and then tubular stomach reconstruction via the posterior mediastinal approach was performed by placing gastric tube in the esophageal bed and closing the posterior mediastinal pleura.Patients received regular perioperative treatment.Intraoperative record included operation time, volume of blood loss, volume of blood transfusion and lymph nodes dissection.Postoperative anastomotic leakage was detected by observing thoracic drainage, symptoms of fever, chest pain and elevated hemogram, recovery of intestinal function and closed thoracic drainage-tube removal time.Follow-up was performed by telephone interview and outpatient examination up to April 2015, including with or without normal food intake, gastroesophageal reflux and tumor progression.Results All the patients underwent successful IovrLewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach without perioperative death and intraoperative blood transfusion.The average operation time, average volume of intraoperative blood loss and average number of lymph nodes dissected were 230 minutes, 300 mL and 16, respectively.Patients received gastric tube removal at postoperative day 2 with a good condition of tubular stomach by CT examination.The average time of postoperative gastrointestinal tract recovery was 3 days.Patients took fluid diet at postoperative day 3-4, soft diet at postoperative day 7 and regular diet at postoperative day 10-12.Two patients complicated with slight pulmonary infection were cured by conventional treatment.The closed thoracic drainage-tube removal time was 4 days.All the patients were followed up for a median time of 8 months (range,1-24 months) with regular diet intake and without perioperative death, tumor recurrence, severe gastroesophageal reflux and other complications.Conclusions Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach is safe and feasible, with the advantages of preventing the esophageal anastomotic fistula, reducing postoperative pulmonary infection and promoting early diet intake and enhancing postoperative recovery of patients.

Objective To establish the proper review rules for the microscopic screening of urine samples tested by automatic urinalysis work station.Methods A total of 3 154 random urine samples were enrolled to establish and validate review rules .All the samples were collected from the inpatients and outpatients of Shanghai First People′s Hospital from March to May 2013 and tested by urinalysis work station.Three thousands one hundred and fifty four urine samples were firstly tested by urinalysis work station,including both urine dry chemical analyzer and urine sediments analyzer .Then each urine sample was examined microscopically by two technicians-in-charge using double-blind method.The average results from the two technicians were used as review results .Compared with review results ,the review rules were set up.According to different test methods by automatic urinalysis work station , four microscopic review protocols were defined:(1)Protocol 1:based on chemistry results only ,microscopy review was performed when any of WBC,RBC,PRO and NIT was positive;(2)Protocol 2:based on urine sedimental analysis only ,microscopy review was performed when any of WBC ,RBC and CAST count was over upper limit of the reference range;(3)Protocol 3:if any of BLD ,RBC,LEU,WBC was different between two systems ,or quantitative results had two or more than two gradient differences ,microscopy review was performed;(4) Protoco1 4:if any of BLD, RBC,LEU ,WBC was different between two systems , or CAST was over upper limit of the reference range , or alarm appeared , microscopic review was performed .400 randomly selected urine samples were tested to validate the review rules .Omission diagnostic rate and review rate were used to evaluate the rules .Results According to the review rules,the positive samples rate was 43.47%(1 371/3 154) and the negative rate was 56.53%( 1 783/3 154 );Positive samples were composed of RBC ( 55.58%) , WBC ( 59.66%) and CAST(6.42%).The review rates of four protocols were 44.48%(1 403/3 154),45.69%(1 441/3 154), 26.09%(823/3 154),28.95%(913/3 154),respectively.The false negative rates (omission diagnostic rates)were 7.13%(225/3 154),4.53%(143/3 154),2.73%(86/3 154) and 1.02%(32/3 154), respectively .Protocol 4 was selected as an ideal plan.Additional 400 urine samples were tested using protocol 4 in order to confirm the review rule.The review rate, false negative rate were 26.25%(105/400), 0.75%( 3/400 ), respectively.After image review revised, the review rate was 14.50%(58/400).Conclusion This study formulates that the automatic urine analysis workstation review rules have clinical maneuverability and validity.