Objective:To study the effect of electroacupuncture (EA) at the Pericardium Meridian on the heart function of volunteers with acute hypoxia, and to provide scientific evidence for the acupoints selection along the affected meridian in acupuncture-moxibustion therapy. Methods:Based on a self-control design, eighteen healthy volunteers were recruited in the study. Points from the Pericardium Meridian [Neiguan (PC 6), Ximen (PC 4), Quze (PC 3) and Tianquan (PC 2)], non-Pericardium Meridian point [Shousanli (LI 10)], non-meridian and non-acupoint points [1.0-1.5 cm lateral to Neiguan (PC 6) and Ximen (PC 4), respectively on both sides], and a blank control (only inhaling low-oxygen gas without EA stimulation) were selected to observe, once every week, 10 sessions in total, and only 1 acupoint was observed once. The volunteers inhaled low-oxygen gas mixture (10.8% O2 and 89.2% N2) for 30 min to imitate acute hypoxia. EA was conducted when the gas mixture was inhaled for 10 min and then lasted for 20 min; meanwhile, hemodynamic indexes such as cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), left cardiac work (LCW), left cardiac work index (LCWI) and heart rate (HR) were recorded on a hemodynamic monitor. Results:EA at the acupoints of Pericardium Meridian significantly down-regulated the increased CO/CI, LCW/LCWI, and HR (P<0.05), and significantly up-regulated the decreased SVR/SVRI in hypoxia (P<0.05); EA at other meridian acupoints or at non-meridian and non-acupoint points didn't produce such effects. Conclusion: EA at the Pericardium Meridian can obviously improve the cardiac hyper-activation caused by acute hypoxia in healthy volunteers.

China has entered an aging society in which the problem about the aged becomes a public concern. The incidence and risk of surgery are much higher in the elderly. Before the surgery，anesthesiologists can identify high-risk surgical patients and deal with them to prepare the patients in a relatively good physical condition. During and after the surgery，anesthesiologists choose the specific treatment for the elderly patients to achieve the best prognosis，by using core anesthesia techniques，including anesthetic drugs，pain management，respiratory- circulation management，and organ protection. This review summarized the core techniques of anesthesiology in elderly patients from the assessment and management perspectives.

OBJECTIVETo review the development, mechanism, necessity and limitation of antiviral therapy in decompensated hepatitis B virus-related cirrhosis.

DATA SOURCESMost information was pulled from a literature search (Pubmed 2000 to 2011) using the keywords of antiviral and decompensated hepatitis B virus-related cirrhosis. Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and review articles on antiviral therapy in decompesated hepatitis B virus-related cirrhosis were selected.

RESULTSSpecific antiviral agents not only control viral replication, which permits liver transplantation, but also improve liver function so significantly that patients could be removed from the transplant waiting list. However, the emergence of drug-resistant mutants can result in treatment failure. Combination therapy is a save-strategy in drug-resistant.

CONCLUSIONSAlthough the treatment of end-stage liver disease is still a challenge worldwide, antiviral therapy has altered the natural history of hepatitis B patients with decompensated cirrhosis. The approval of the new generation of antivirals is opening new perspectives for finding the optimal antiviral treatment for patients with decompensated cirrhosis and preventing antiviral resistance. A combination of antivirals may be one of the future strategies for fulfilling these goals.

Antiviral Agents ; therapeutic use ; Hepatitis B virus ; drug effects ; pathogenicity ; Humans ; Liver Cirrhosis ; drug therapy ; virology

OBJECTIVETo observe the effect of hepatitis virus B on the detection rate of core antigen of hepatitis virus C in sera of chronic hepatitis C patients.

METHODHCVcAg and HCV RNA in sera were detected in 88 patients with chronic hepatitis C and 62 patients co-infected with HCV and HBV. At the same time, HBV DNA and HBeAg in sera were detected in 62 patients infected with HCV and HBV. Then we analyzed the correlation between HCVcAg and HBeAg/HBV DNA. The detection rates of HCVcAg in 88 patients with chronic hepatitis C and 62 patients co-infected with HCV and HBV were 72.7% (64/88) and 38.7% (24/62), respectively (x2 = 17.358, P less than 0.01).

RESULTSThe detection rates of HCV RNA in 88 patients with chronic hepatitis C and 62 patients co-infected with HCV and HBV was 81.8% (72/88) and 53.2% (33/62)respectively (x2=20.110, P less than 0.01). In 62 patients infected with HCV and HBV, the detection rate of HCVcAg in HBeAg positive patients and HBeAg negative patients were 28.6% (12/42) and 60% (12/20), respectively (x2 = 7.547, P = 0.011). Moreover, the positive rates of HBV DNA in HBeAg positive patients and HBeAg negative patients were 42.9% (18/42) and 80% (16/20), respectively (P more than 0.05). The detection rates of HCVcAg in HBV DNA positive patients and HBV DNA negative patients were 39.1% (18/46) and 37.5% (6/16), respectively (x2 = 0.013, P = 0.908). Compared with the detection rates of HCVcAg in patients only infected with HCV, the detection rate of HCVcAg in HBeAg or HBV DNA negative patients infected with HCV and HBV were 60% (12/20) (x2 = 1.266, P = 0.261) and 37.5% (6/16) (x2 =7.635, P less than 0.01), respectively.

CONCLUSIONThe detection rate of HCVcAg in patients infected with HCV and HBV is relatively low. The reason is possibly that HBeAg inhibits duplication of HCV and decreases the expression of HCVcAg.

Coinfection ; immunology ; virology ; DNA, Viral ; Hepacivirus ; immunology ; Hepatitis B ; immunology ; virology ; Hepatitis B virus ; Hepatitis C Antigens ; blood ; Hepatitis C, Chronic ; immunology ; virology ; Humans

Objective：This study was designed to evaluate the genetic stability on chromosome 16q22 24 in primary nasopharyngeal carcinoma. Methods: Tissue samples from fifty patients with nasopharyngeal carcinoma (NPC) tumors were examined by loss of heterozygosity (LOH) and microsatellite instability (MSI) analysis with a panel of 8 microsatellite polymorphic markers distributed along the chromosome 16q22 24. Results: LOH was observed at one or more loci in 24 cases (48％ ) and the prevalence of MSI was detected in 9 cases (18％ ). But the genomic alterations scattered along the region, neither common deletion or instability region was found. Conclusions: The status of genetic stability in chromosome 16q22 24 suggests that the genomic alterations on chromosome 16q22 24 may be involved in the development of NPC.

【Objective】Through summarizing the clinical manifestations and gene mutations of 5 types of RASopathies in childhood including Neurofibromatosis type1（NF1），Noonan syndrome（NS），Noonan syndrome with multiple lentigines（NSML），Costello syndrome（CS）and cardio-facio-cutaneous syndrome（CFC）and analyzing their commonalities and characteristics，to deepen the clinician′s understanding of the RASopathies and improve the domestic doctors′ diagnosis and treatment level of RASopathies.【Methods】The clinical data and gene mutation types of 11 patients of RASopathies who were diagnosed in Sun Yat- Sen Memorial Hospital from January 2015 to May 2018 were retrospectively analyzed. 【Results】The age of onset ranged from 6 months to 12 years and the main clinical manifestations of 11 patients included： short stature，craniofacial features，congenital heart defect，café-au-lait macules，developmental delay，thrombocytopenia， seizures and dystonia，cryptorchidism，etc. Five gene mutations were detected including NF1 gene，PTPN11 gene， RAF1 gene ，BRAF gene and HRAS gene.【Conclusions】The RASopathies are a clinically defined group of medical genetic syndromes caused by germline mutations in genes that encode components or regulators of the Ras/MAPK pathway. The RAS/MAPK pathway plays an important role in regulating growth development，promoting cell proliferation，differentiation，metabolism，and signal transduction of various hormones. Therefore，they share many overlapping characteristics，including craniofacial features，growth retardation，cardiac malformations，cutaneous and musculoskeletal abnormalities，neurocognitive impairment and tumor susceptibility. However ，each RASopathy exhibits different degree phenotypes because of mutations at different points in the pathway. In addition ，tumor susceptibility is one of the typical clinical features of RASopathies. Therefore，tumor monitoring is one of the most important contents in the follow-up process.

OBJECTIVETo investigate the effects of oral intake of glucose solution before surgery on the pH at the lower esophagus, perioperative blood glucose level, and plasmic protein in patients undergoing radical resection for colorectal cancer.

METHODSBetween January 2008 and December 2008, 60 patients undergoing radical surgery for colorectal cancer were enrolled and randomized into three groups using the table of random digits. Four patients were withdrawn from the study. Patients in group A (n=19) were given 800 ml of 12.5% glucose solution for oral intake the night before surgery, and 200 ml two hours before surgery. Patients in group B (n=19) were given distilled water instead of glucose. Patients in group C (n=18) were asked to fast for 8-12 hours before operation. Combined general and epidural anesthesia was used. pH at the lower esophagus was monitored during intubation and extubation. Albumin, transferrin, prealbumin, insulin, and fasting blood glucose were measured before surgery and at postoperative day 1, 3, and 7.

RESULTSpH at the lower esophagus was 8.05±0.43 in group A, 7.98±0.41 in group B, and 7.94±0.41 in group C. There were no perioperative acid regurgitations (P>0.05). Serum insulin in group A at postoperative day 1 was (16.32±16.11) μU/L, which was significantly lower than that in group B (30.65±41.74) μU/L and group C (34.01±52.91) μU/L. Log HOMA-IR in group A at postoperative day 1 was significantly lower than that in group B and group C (0.49±0.35 vs. 0.59±0.56 and 0.60±0.63, P<0.05). Transferrin in group C at postoperative day 3 and 7 was significantly lower than that in the other two groups, as was albumin at postoperative day 3 (P<0.05).

CONCLUSIONOral liquid intake 2 hours before surgery is not associated with increased risk of regurgitation or aspiration during intubation and extubation, and may glucose solution intake reduce insulin resistance and protein degradation after colorectal surgery.

Administration, Oral ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Proteins ; metabolism ; Colorectal Neoplasms ; metabolism ; surgery ; Female ; Glucose ; therapeutic use ; Humans ; Hydrogen-Ion Concentration ; drug effects ; Insulin Resistance ; Intraoperative Period ; Male ; Middle Aged ; Preoperative Care ; Young Adult

ObjectiveTo study the changes of miRNAs in exosomes secreted from microglia after being activated by exosomes of SH-SY5Y cells overexpressing α-synuclein （SNCA-HM Exo） and their effects on autophagy of SH-SY5Y cells． MethodsMicroglia exosomes were collected for miRNAs microarray analysis and PCR detection， and the differentially expressed miRNAs were screened out. Their target genes were analyzed by Kyoto Encyclopedia of Genes and Genomes （KEGG） and Gene Ontology （GO）. MiRNAs and their target genes related to PI3K/Akt/signaling pathway were screened out and verified by Western blot. The SH-SY5Y cells were divided into four groups：Con-HM Exo，Con-HM Exo+miR-19a mimic，SNCA-HM Exo and SNCA-HM Exo+miR-19a-3p inhibitor. ResultsFifteen differentially expressed miRNAs were screened out by microarray analysis and PCR. KEGG and GO analysis showed that PI3K/Akt signaling pathway had the highest enrichment score of target genes， and PTEN was one of the target genes regulated by mir-19a-3p. We found that， compared with the control group， the expression of PTEN and LC3 Ⅱ/I were decreased， while the expression of p-Akt/Akt， p-mTOR/mTOR and p62 were increased in the miR-19a-3p mimic group and the SNCA-HM Exo group （P < 0.05）. However， miR-19a-3p inhibitor could reverse this effect （P < 0.05）. ConclusionSNCA-HM Exo regulates PTEN through miR-19a-3p， activates PI3K/Akt/mTOR signaling pathway， and then inhibits autophagy in SH-SY5Y cells．

【Objective】 The purpose of this study was to investigate puberty development in β-TM patients and to analyze its clinical characteristics and influencing factors. 【Methods】 A total of 42 β-TM patients aged ≥10 years old were evaluated for their stages of puberty development by reviewing follow-up data(using the REDCAP system, the thalassemia follow-up database), questionnaire, physical examination and laboratory tests. To investigate The correlations between multiple factors, such as age, beginning age of iron chelation, iron overload and so on, and abnormal puberty development in β-TM patients, were investigated. 【Results】 Twenty-four cases of β-TM patients were diagnosed as abnormal puberty development, including 11 girls and 13 boys. The common clinical manifestations of β-TM patients with abnormal puberty development were delayed puberty development and primary amenorrhea for girls and short penis and small testicles for boys. The prevalence rate of abnormal puberty development was significantly higher in β-TM patients who had older beginning age of iron chelation, β0β0 genotype, a history of splenectomy, vitamin D deficiency and diabetes(χ² = 3.966, 5.196, 5.567, 4.714, P = 0.046, 0.023, 0.018, 0.030). The result of logistic regression analysis indicated that cardiac MRT2* < 20 ms was an independent risk factor for abnormal puberty development in β-TM patients. 【Conclusions】 Abnormal puberty development in β-TM patients is very common. Influencing factors include beginning age of iron chelation, β0β0 genotype, vitamin D deficiency, diabetes and cardiac iron deposition. Moreover, hypogonadotropic hypogonadism may be an important pathogenesis of abnormal puberty development in β-TM patients.

【Objective】 To quantify the myocardial, hepatic and pancreatic iron overload in β-thalassemia major(β-TM) using MRI T2* technique, and to analyze the relationship of iron deposition between the liver, pancreas and myocardium. 【Methods】 A total of 109 β-TM patients were enrolled in this retrospective study. Clinical and laboratory data were collected and patients were performed 1.5T T2* sequence MR scan on the heart, liver and pancreas. The spearman rank correlation was employed to analyze the relationship between liver T2*, pancreas T2* and myocardium T2*. Wilcoxon rank sum test was used to compare liver T2* values in the two groups: group A(n=32) with patients suffering from both myocardium iron overload(MIO) and liver iron overload(LIO), group B(n=69) with patients suffering from LIO only. Wilcoxon rank sum test was used to compare pancreas T2* values in another two groups: group C(n=34) with patients suffering from both MIO and pancreas iron overload(PIO), group D(n=58) with patients suffering from PIO only. Receiver operating characteristic(ROC) analysis was used to calculate the possibility of using hepatic and pancreatic iron as a predictor of myocardium iron deposition. 【Results】 The median T2* of myocardium, liver and pancreas of the 109 β-TM patients was 27.7(3.2~45.4) ms, 1.8(0.7~18.6) ms, 6.1(1.1~42.9) ms, respectively. With the cut-off level of 20 ms, MIO was detected in 34 cases(31.2%), the youngest one being 7 years old. With the cut-off level of 6.3 ms, LIO was detected in 101 cases(92.7%), the youngest being 5 years old. With the cut-off level of 26 ms, PIO was detected in 92 cases(84.4%), the youngest being 5 years old. Both liver T2*(r= 0.453, P<0.001) and pancreas T2*(r= 0.597, P<0.001) were positively correlated with myocardium T2*. Liver T2* values in group A were lower than those in group B(Z=3.048, P=0.002). Pancreas T2* values in group C were lower than those in group D(Z=6.682, P<0.001). ROC analysis of liver and pancreas R2*(1/T2*) for diagnosing MIO revealed significant distinguishing power of liver R2*(P=0.009) and pancreas R2*(P< 0.001), with area under the curve(AUC) of 0.660, 0.933 and 95% confidence interval of 0.543-0.777, 0.881-0.985, respectively. 【Conclusions】 Liver and pancreas iron overload occurr early and overwhelmingly in β-TM patients. Iron deposits earlier in the liver and pancreas than that in the myocardium. Both hepatic and pancreatic iron level are correlated with myocardial iron level, and can be predictors of the latter.