Autophagy is a cellular catabolic pathway that is essential for survival,differentiation,development and homeostasis.The dual roles of autophagy as a tumor-promoting mechanism and a tumor suppressor mechanism have been elucidated in the recent cancer research.The double function is accomplished by some neoplasms-associated signaling pathways which include mTOR-dependent signaling pathway,Beclin1 network,LKB1-AMPK signaling pathway,p53 and p53-related regulators of autophagy.Thus it can be seen that these signaling pathways function dependently and correlatively as inducing and inhibiting autophagy and play different roles in the process that involves growth and development of neoplasms.

Objective To investigate the lung CT findings in patients with primary Sj(o)gren's syndrome (pSS) and clinical significance.Methods Images of lung CT scans of 68 patients with pSS were retrospectively observed.The distribution characteristics of lung lesions were observed.CT visual score were used to quantitatively analyze lung lesions.Binary classification unconditional logistic regression analysis was used to investigate the relationship between pulmonary arterial hypertension (PAH) and anti-SSB seropositivity in Patients with pSS.Results The 68 cases of patients with pSS,PAH in 13 (19％),anti-SSB seropositivity in 25(37％),CT shows normal in 13 (19％),interlobular septal thickening,ground-glass opacity and intralobular interstitial thickening were frequent findings.The lesion distribution was in the peripheral and lower lung fields.Interlobular septal thickening and cysts were associated with PAH in Patients with pSS (OR=1.780,2.513,P＜0.05),cysts was significantly associated with anti-SSB seropositivity (OR =10.530,P＜0.05).Conclusion Lung CT can quantitatively analyze the degree of pSS lung damage,and provide helps for clinical treatment and prognosis.

Objective To observe the effect of electroacupuncture at Baihui (GV20) and Shenting (GV24) on learning-memory function and ultrastructure in hippocampal CA1 region of rats after cerebral ischmeia-reperfusion. Methods A total of 25 male Sprague-Dawley rats were randomly divided into sham group (n=6) and operation group (n=19). The operation group was occluded the left middle cerebral arter-ies with modified Longa's methods for 90 minutes and reperfused, and twelve qualified rats of them were randomly divided into model group (n=6) and electroacupuncture group (n=6), the later accepted electroacupuncture at Baihui and Shenting for seven days. They were as-sessed with Longa's scores, and tested with Barnes maze. Their cerebral infarct volume was tested with magnetic resonance imaging T2-weighted image. The ultrastructure of synapse in hippocampal CA1 region was observed with transmission electron microscope. Results Compared with the model group, the Longa's score improved (P<0.05), the infarct volume decreased (P<0.01), the average escape latency decreased (P<0.01) and the times entering the wrong hole decreased (P<0.001) in the electroacupuncture group. Under the transmission elec-tron microscope, the number of synapse decreased in the model group, with the structure damage and vesicles sparse;compared with the model group, the number of synapse increased in the electroacupuncture group, with clear and complete structure and rich vesicles. Conclu-sion Electroacupuncture at Baihui and Shenting can improve the learning-memory function in rats after cerebral ischmeia-reperfusion, which may relate to improvement of synaptic plasticity and ameliorating ultrastructure in hippocampal CA1 region.

Objective To review the experience with partial cystectomy combined with chemo-and radiation therapies in the treatment of muscle-invasive bladder cancer (MIBC) to assess the local control and survival rates,and to identify predictive factors for recurrence and survival.Methods From 2002 through 2007,a total of 100 patients with MIBC underwent partial cystectomy combined with adjuvant chemotherapy and radiation therapy (PC group).Meanwhile,36 patients with MIBC underwent radical cystectomy (RC group).The clinical and pathological data of these patients were retrospectively reviewed.Primary endpoints were cancer-specific survival (CSS),bladder-intact cancer-specific survival and bladder cancer recurrence.Results The 5-year CSS rate of the entire cohort was 65％,which was higher in PC group than in RC group (68％ vs 55％,P =0.033).In PC group,only 2 patients (2％) were confirmed to have residual tumor at the time of re-evaluation TUR 3 months after partial cystectomy.After a mean of 33.1 months,46 patients (46％) experienced superficial recurrence and 14 patients (14％) developed muscle-invasive recurrence.75％ of recurrence occurred within 16 months.8 patients underwent salvage cystectomy.The 5-year bladder-intact survival rate was 63％ in PC group.In multivariate analysis,the presence of tumor numbers more than 3 and tumors with infiltrating growth pattern were 2 predictive factors for cancer recurrence in PC group.In terms of survival,the presence of tumor numbers more than 3,lymphovascular invasion and partial cystectomy plus ureteral reimplantation (PC plus UR) were significantly associated with 5-y CSS in PC group and PC plus UR was indeed a protective factor for survival.By looking at the entire MIBC cohort,lymphovascular invasion,tumor numbers more than 3,history of superficial bladder cancer and age greater than 70 years old were identified as independent predictive factors for 5-y CSS.Conclusions Combined with adjuvant chemo-and radiation therapies,partial cystectomy might be a alternative to radical cystectomy for the treatment of MIBC,which provides adequate local control in selected patients,as well as acceptable survival rate.

Objective:To observe the clinical efficacy of Heweishupiyin decoction in the treatment of functional dyspepsia (FD) in elderly patients with liver stagnation and spleen deficiency.Methods:A randomized controlled method was performed in this study, and 70 FD patients were selected from February 2018 to June 2019 in accordance with the inclusion criteria.The patients were divided into the observation group and the control group according to the random digital table method, with 35 cases in each group.The observation group was treated with Heweishupiyin decoction, the control group was given mosapride citrate tablets.The period of treatment was 4 weeks.The changes of total symptom scores, TCM syndrome evaluation, electrogastrogram (EGG) parameters, serum serotonin, and Hamilton depression scale (HAMD) scores before and after treatment were recorded.The statistical analysis was performed to evaluate the clinical efficacy of Heweishupiyin decoction.Results:After treatment, the overall symptom scores in both two groups were decreased.The overall symptom score of the observation group after treatment[(8.03±4.23)points] was lower than that of the control group[(10.36±4.67)points], and the difference was statistically significant( t=2.145, P<0.05). The overall efficacy of TCM symptoms of the observation group was 88.2% (30/35), which was significantly higher than 72.8% (24/35) of the control group ( Z=-2.473, P<0.05). After treatment, the EGG parameters of two groups had different degrees of increase, the main frequency of the observation group after meal[(3.39±0.34)cpm] was higher than that of the control group[(3.18±0.36)cpm], the difference was statistically significant( t=-2.202, P<0.05). The percentage of normal slow wave in the observation group[(68.91±4.79)%] was higher than that in the control group[(66.33±3.00)%], and the difference was statistically significant( t=-2.549, P<0.05). The reaction area of the observation group[(99.09±13.58)μV/s] was higher than that of the control group[(90.27±14.70)μV/s], and the difference was statistically significant( t=-2.390, P<0.05). After 4 weeks of treatment, the HAMD score of the observation group[(14.94±2.42)points] was lower than that of the control group[(16.94±4.29)points], and the difference was statistically significant( t=2.355, P<0.05). The serum level of serotonin after treatment in the observation group[(110.46±16.69)μmol/L] was higher than that in the control group[(99.04±19.86)μmol/L], the difference was statistically significant( t=-2.551, P<0.05). Conclusion:Heweishupiyin decoction is superior to mosapride citrate tablets in improving the overall symptomatic efficacy and TCM syndrome efficacy of FD patients with liver stagnation and spleen deficiency.Heweishupiyin not only can improve the depression state of FD in the elderly, but also has the effect of improving the gastric electrical rhythm disorder, which may be related to the regulation of serum serotonin levels.

Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.

Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors.Methods From January 2015 to March 2017,the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively.There were 31 males and 17 females,and the mean age was 57 years (range:23-84 years).The mean tumor size was 3.1 cm (range:1.2-6.4 cm),with the upper,middle,and lower polar tumors account for 35.4％,27.1％,and 37.5％,respectively.The clinical tumor stage was T1N0M0 in all 48 cases,according to the AJCC tumor staging system for renal cancer.Results RAPNs were performed successfully in all 48 cases,without conversion to open surgery.In those patients,the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases.The renal artery and vein was exposed,dissected,isolated and then clamped in 4 cases due to bleeding.The mean surgical time was 85 min (range:75-185 min).The mean estimated blood loss was 134 ml (range:60-270 ml),and no blood transfusion was needed.The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point.The mean time for renorrhaphy was 22 min (rang:11-31 min).No intraoperative severe complications such as vascular injury,trauma of abdominal organ occurred.There were 5 complications,including 2 cases of hematuria,2 cases of delayed healing of incision,and 1 case of pneumohypoderma.The pathological diagnosis included 40 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 5 cases of angiomyolipomas.No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months).Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors.It carries the benefits of less complication,quick recovery,and less ischemia reperfusion renal injury.Off-clamping RAPN would be suitable for those patients with solitary kidneys,renal insufficiency,and bilateral tumors.

Objective To investigate the effects of WNK3 kinase on the regulation of large-conductance calcium-activated potassium channels (Maxi K channels) on African green monkey kidney fibroblast-like cells (Cos-7 cells) and its mechanisms.Methods (1) Cos-7 cells were transfected with 0,0.6,1.2,1.8 μg WNK3 plasmid+0.5 μg Maxi K plasmid.The total protein expression of Maxi K channel and the phosphorylation of mitogen-activated protein kinase (MAPK) extracellular regulated kinase-1 and-2 (ERK1/2) were detected by Western blotting.(2) Cos-7 cells were divided into the control group (2.5 μg Maxi K plasmid) and the experimental group (2.5 μg WNK3 plasmid+2.5 μg Maxi K plasmid).Cell surface biotinylation was used to investigate the cell surface protein expression of Maxi K channel in Cos-7 cells.Immunoprecipitation and Western blotting were used to detect the ubiquitination of Maxi K channel protein.(3) WNK3 kinase was knocked down by WNK3 siRNA.The lysosomal degradation pathway was blocked by the proton pump inhibitor (Baf-A1).Cos-7 cells were divided into Maxi K+negative control siRNA group,Maxi K+WNK3 siRNA group and Maxi K+WNK3 siRNA+Baf-A1 group.The protein expression of Maxi K channel protein was detected by Western blotting.Results (1) Compared with those in 0 μg WNK3 plasmid groups,in 0.6,1.2,1.8 μg WNK3 plasmid groups the total protein expression of the Maxi K channel increased and the phosphorylation level of MAPK ERK1/2 reduced on a dose-dependent manner (all P ＜ 0.01).(2)Compared with those in the control group,the total protein expression and cell surface membrane protein expression of the Maxi K channel increased in the experimental group (P ＜ 0.01),while the ubiquitination of the Maxi K channel protein reduced (P ＜ 0.01).(3) Compared with the Maxi K +negative control siRNA group,the expression of Maxi K protein reduced in the Maxi K+WNK3 siRNA group (P ＜ 0.01),but did not change in the Maxi K+WNK3 siRNA + Bar-A1 group (P ＞ 0.05).The expression of Maxi K protein in Maxi K+WNK3 siRNA+Baf-A1 group was higher than that in Maxi K+WNK3 siRNA group (P ＜ 0.01).Conclusions WNK3 kinase inhibits the lysosomal degradation pathway of Maxi K channel protein by reducing the ubiquitination of Maxi K channel,and promotes the expression of Maxi K channel protein in cells and on cell membrane.These effects may be achieved by suppressing MAPK ERK1/2 signal transduction pathway.

Objective To observe the effect of electroacupuncture at Baihui (DU20) and Shenting (DU24) on brain functional activity and working memory of rats with vascular cognitive impairment (VCI). Methods Eighteen Sprague-Dawley rats were included, in which twelve rats were ligated bilateral common carotid arteries and six rats were not ligated (sham group). The modeled rats were randomly divided into model group (n = 6) and electroacupuncture group (n = 6). The electroacupuncture group received electroacupuncture at Baihui and Shenting for four weeks. They were assessed with Y maze and Morris water maze before and after intervention, and scaned with resting-state functional magnetic resonance imaging after intervention to calculate regional homogeneity (ReHo). Results Compared with the sham group, alternation rate of Y maze decreased (P < 0.001), and escape latency of Morris water maze increased (P < 0.05) in the model group and the electroacupuncture group before intervention. Compared with the model group, alternation rate of Y maze increased (P < 0.05), and escape latency of Morris water maze decreased (P < 0.05) after intervention in the electroacupuncture group. Compared with the sham group, ReHo of bilateral hippocampus, olfactory cortex, sensory cortex and auditory cortex, and left striatum decreased in the model group; compared with the model group, ReHo of bilateral prefrontal lobe, hippocampus and olfactory cortex, and left amygdala increased in the electroacupuncture group. Conclusion Electroacupuncture at Baihui and Shenting can improve the memory function of VCI rats, which may be related to the functional activities of prefrontal lobes, hippocampus and amygdala.