This study aimed at preparing the chemical reference substance of garcinol.A preparative high-speed countercurrent chromatography (HSCCC) was adopted for the isolation of garcinol from the twigs of Garcinia multifiora Champ,G.esculenta Y.H.Li and the fruits of G.xanthochymus Hook.f.ex T.Anders.The crude extracts were separated by HSCCC with two phase solvent systems composed of n-hexane-ethyl acetate-95％ ethanol-water (8∶8∶12∶4,volume ratio) using the upper stationary phase and the lower mobile phase.Under the conditions of a flow rate of 2.0 and 4.0 mL· min-1,and the apparatus rotation at 850 rpm,the column temperature at 25℃ and the detection wavelength at 254 nm,the fraction containing garcinol was purified by the Sephadex LH20 chromatography.The purity test in the extracts was determined by high-performance liquid chromatography.As a result,the contents of garcinol were 45,281 and 4080mg respectively separated from 104.765 g twigs of G.multiflora Champ,105.270 g G.esculenta Y.H.Li and 102.318 g the fruits of G.xanthochymus Hook.f.ex T.with the purity of 98.72％,98.36％ and 98.42％.Compared with the sample pretreatments and separation efficiency of the three plants,it was found that the fat-soluble extracts rapidly and efficiently extracted using n-hexane-ethyl acetate-95％ ethanol-water (5∶5∶5∶5,volume ratio) contained abundant garcinol taking fruits of G.xanthochymus Hook.f.ex T as the raw material with the combination of HSCCC and Sephadex LH-20 chromatography.In conclusion,it was indicated that the combination method is efficient with high operability and large preparation quantity.

Objective To explore the value of ~(18)F 2-deoxy-2-fluoro-d-glucose(~(18)F-FDG)positron e-mission tomography (PET)/computed tomographic (CT) imaging and CT perfusion in evaluating metabolic and blood flow characteristics in breast cancer.Methods 32 women with untreated breast masses were both ex-amined with ~(18)F-FDG PET/CT and CT perfusion at the same day.All the lesions were confirmed histopothologi-cally by surgery or biopsy.The PET/CT images were analyzed semi-quantitatively.CT perfusion images were analyzed using the GE perfusion 3 soft package.The findings of two modalities above were commed with patho-logical diagnosis.Results There were significant differences between standardized uptake values (SUVs) of ~(18)F-FDG of benign tumors and breast cancer (Wilcoxon test:P=0.000 3,T=15.000,u=3.433,C=1).Differ-ences of SUVs between the center and periphery of breast Inasses were also significant.In addition.the SUVs were related to the pathological type and the grading of tumors.In the CT perfnsion,the differences of perfusion including bloodflow (BF),blood volume(BV)and permeability surface area product (PS) values between tumor and normal breast tissue were statistically significant(t=8.065,P<0.000 1;t=2.769 1,P=0.011 5;T~+=253.000 0,T~- =0.000 0,P<0.000 1)respectively.The differences of BF,BV and PS values between pe-ripheral zone and central portions of tumor were also statistically significant (t=8.015 8,P<0.000 1;t=2.243 4,P=O.017 9;t=3.485 7,P=0.002 2),respectively.Conclusion ~(18)F-FDG PET/CT imaging and CT peffusion reveal the metabolic and blood flow characteristics,and reflect biological behavior of breast tumor indirectly and have important value for the diagnosis and prognosis of breast cancer.

Objective To evaluate the detection rates of colorectal polyps and cancer in the elderly and characterize the pathological features of the colorectal neoplasm in DongLi District in Tianjin.Method Totally,46 743 subjects aged 60-74 were recruited from the national colorectal cancer screening program,including subjects registered from November 2012 to April 2013 in DongLi District in Tianjin.Each subject completed a questionnaire and a fecal occult blood test.Colonoscopies were conducted in 434 subjects with high risk for colorectal cancer.Results Among all the subjects,2 880 were at high risk for colorectal cancer which accounts for 6.16％ (2 880/46 743) of the total subjects.Among the subjects who underwent the colonoscopy,165 (men:105,women:60) were colorectal polyps accounting for 5.73％ (165/2 880)in the total risk,with 51 subjects (1.77％) advanced neoplasms and 4 subjects (0.14％) cancer.The detection rates of colorectal polyps is 0.35％ (165/46 743),and colorectal cancer is 8.6/105(4/46 743).More polyps were found on the left colon compared with the right.More tubular adenoma was found compared with the other pathological types.Most of the polyps were smaller than 0.5 cm.Colorectal polyps and advanced neoplasms were more frequent in men than women [45.45％ (105/231) vs 29.56％ (60/203),16.02％ (37/231) vs 6.90％ (14/203),all P ＜ 0.01].Multiple polyps (P ＜ 0.05) and polyps with diameter larger than 1.0 cm (P ＜ 0.01) were more often in men than in women.Men tended to have more colorectal polyps in right colon and higher detection rate for moderate or sever atypical hyperplasia than women(all P ＜ 0.05).Conclusion There is a higher incidence of colorectal polyps in the elderly.It is important to establish the national sequential colorectal cancer screening program for the early diagnoses of colorectal polyps and cancer in the elderly.

In recent years,immunotherapy has gradually become a new treatment method of neoplasms,and the patients with solid tumors can benefit from immunotherapy.Immunotherapy has also been used in the treatment of non-small cell lung cancer (NSCLC),which shows a remarkable effect.At present,programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors have achieved obvious effects in the treatment of NSCLC.With the continuous study of clinical trials,immunosuppressants have obtained indications in the first-line and second-line treatment of advanced NSCLC.This new treatment changes the treatment mode of lung cancer,and it also brings challenges for the treatment of efficacy evaluation and treatment-related adverse reactions of the tumors.This review summarizes the progress of immunotherapy as the first-line treatment of patients with advanced NSCLC.

OBJECTIVETo investigate effects of systemic red light therapy on wound repair of burned patients and discuss its possible mechanisms of wound healing promotion.

METHODS138 burned patients were randomly divided into systemic red light treatment group (n = 69) and control group (n = 69). Patients in control group received routine therapy, while those in test group were given systemic red light therapy once a day, 30 minutes at a time until the wounds were recovered. The clinical findings and variables indicating wound repair were assessed on the 7th, 10th, 14th day, 21st day post-burn and the day when the wounds were healed.

RESULTSMean time of wound recovery were 19.86 +/- 2.43 days and 21.02 +/- 2.97 days respectively of those deep-thickness wounds in test group and control group, with statistically significance (P < 0.05). For the severity of the pain, VAS during time of dressing change on the 10th, 14th day post burn was lower in test group than that in control group which indicated less painful in test group (P < 0.05), suggesting pain relief effect of systemic red light therapy.

CONCLUSIONSystemic red light therapy was effective to promote wound healing of deep-thickness burn wounds and other similar acute wounds. Simultaneously, it is efficacious in pain relief and safe for those patients.

Adolescent ; Adult ; Aged ; Burns ; therapy ; Female ; Humans ; Light ; Male ; Middle Aged ; Pain Management ; Phototherapy ; Treatment Outcome ; Wound Healing ; Young Adult

Objective: To study clinical characteristics and treatment after colonscopic perforation, and to determine risk factors for postoperative complications. Methods: Cases diagnosed as colonoscopic perforation within 7 days after colonoscopy in Peking Union Medical College Hospital between January 2010 and January 2017 were reviewed. Data regarding demography (age, sex), clinical information (comorbidities, medication history of glucocorticoid, length of hospital stay), colonoscopy (whether endoscopic therapy or anesthesia was performed, intestinal cleanliness), perforation (region, diagnosing time) and operation (laparotomy or laparoscopic operation, procedure, post-operational complications) were collected. Single factor analysis and Spearman correlation analysis were employed to determine the risk factors of postoperative complications. Results: A total of 14 colonoscopic perforation cases were identified and included in this study, and the overall perforation rate was 0.03%. Most perforations occurred in rectum (2 cases) and sigmoid colon (8 cases). Twelve perforation patients received operational treatment, of who 6 developed postoperative complications, including 3 cases of incision infection, 2 cases of peritoneal infection, 1 case of catheter-related infection and 1 case of pulmonary embolism. Spearman correlation analysis showed that preoperative medication of glucocorticoid and non-rectosigmoid perforation were positively related to postoperative complications (both correlation coefficients were 0.707, P=0.01), while perforation diagnosed immediately and satisfying intestinal cleanliness were negatively related to it (both correlation coefficients were -0.667, P<0.05). Conclusion Perforations are rare but severe complications of colonoscopy, and surgical interventions are necessary in most cases. Postoperative complications were significantly related to perforation sites, preoperative medication of glucocorticoid, perforation diagnosis time and intestinal cleanliness.

Objective: To observe the effect of ulinastatin combined with glutamine on early hemodynamics in patients with severe burns. Methods: Thirty-two patients with severe burns who met the inclusion criteria and hospitalized in the Affiliated Huaihai Hospital of Xuzhou Medical University from January 2016 to December 2018 were selected for conducting a prospective randomized controlled trial. According to the random number table, the patients were divided into conventional treatment group (4 males and 4 females), ulinastatin group (5 males and 3 females), glutamine group (5 males and 3 females), and ulinastatin+ glutamine group (4 males and 4 females), with ages of (36±8), (34±8), (35±9), and (38±13) years in turn. From post injury day 2, patients in the 4 groups were given nutritional support of equal nitrogen and equal calories, of which protein was 2.0 g/kg daily. In addition, patients in the ulinastatin group received intravenous injection of 100 kU ulinastatin every 8 hours for 7 consecutive days; 0.3 g/kg of protein given to patients in the glutamine group was provided by alanine glutamine for 7 consecutive days; patients in the ulinastatin+ glutamine group received corresponding treatments of both ulinastatin group and glutamine group. With the help of pulse contour cardiac output (PiCCO) monitoring technology, the cardiac index, stroke volume index (SVI), global end-diastolic volume index (GEDI), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) of patients in each group were measured on treatment day (TD) 1, 3, and 7. Data were processed with Fisher′s exact probability method, one-way analysis of variance, analysis of variance for repeated measurement, and Bonferroni method. Results: The cardiac index was low and the SVI value was lower than the normal value on TD 1 in patients of the 4 groups, without statistically significant differences between any two groups (P>0.05), and then they were all gradually increased. On TD 3 and 7, compared with those of the conventional treatment group, the cardiac index and SVI of patients in the other three groups were all increased, and the cardiac index and SVI of patients in the ulinastatin+ glutamine group were significantly increased (P<0.05 or P<0.01). On TD 1, the GEDI of patients in the conventional treatment group, ulinastatin group, glutamine group, and ulinastatin+ glutamine group were at normal low levels, which were (659±58), (661±79), (659±88), and (653±71) mL/m² respectively, without statistically significant differences between any two groups (P>0.05), and then they all gradually increased. On TD 3 and 7, compared with (684±82) and (742±46) mL/m² of the conventional treatment group, the GEDI of patients in the ulinastatin group, glutamine group, and ulinastatin+ glutamine group were all elevated, which were (732±53) and (777±33), (725±58) and (783±49), (813±65) and (849±27) mL/m² respectively, and the GEDI of patients in the ulinastatin+ glutamine group was significantly increased (P<0.05). The SVRI of patients in the four groups were all at high levels on TD 1, without statistically significant differences between any two groups (P>0.05), and then they all gradually decreased. On TD 3 and 7, compared with those of the conventional treatment group, the SVRI of patients in the other three groups were all increased, and the SVRI in the ulinastatin+ glutamine group was significantly increased (P<0.05). On TD 1, the EVLWI of patients in the conventional treatment group, ulinastatin group, glutamine group, and ulinastatin+ glutamine group were all in the normal range, which were (6.6±0.6), (6.3±0.4), (6.5±0.4), and (6.6±0.6) mL/kg respectively, without statistically significant differences between any two groups (P>0.05), and then they all showed the increasing trend. On TD 3 and 7, compared with (7.1±0.9) and (7.9±0.5) mL/kg of the conventional treatment group, the EVLWI of patients in the ulinastatin group, glutamine group, and ulinastatin+ glutamine group were all decreased, which were (6.2±0.6) and (7.1±0.4), (6.3±1.0) and (7.2±0.9), (5.8±0.7) and (6.7±0.6) mL/kg respectively, and the EVLWI of patients in the ulinastatin+ glutamine group was significantly decreased (P<0.05). On TD 1, the PVPI of patients in the four groups were all in the normal range, without statistically significant differences between any two groups (P>0.05), and then they all gradually decreased. On TD 3 and 7, compared with those of the conventional treatment group, the PVPI of patients in the other three groups were all decreased, and the PVPI in the ulinastatin+ glutamine group was significantly decreased (P<0.05). Conclusions Ulinastatin combined with glutamine can increase the cardiac index, SVI, GEDI, and SVRI and reduce the EVLWI and PVPI in treating patients with severe burns, thereby increasing early cardiac output after injury, promoting tissue and organ perfusion, and reducing pulmonary edema, resulting in significant improvement in early hemodynamics of patients with severe burns.

Objective To conclude the intraductal ultrasonography ( IDUS ) characteristics of cholangiocarcinoma and improve endoscopic diagnosis for cholangiocarcinoma by comparing manifestations of IDUS between cholangiocarcinoma and benign bile duct stricture. Methods A total of 52 patients undergoing endoscopic retrograde cholangiopancreatography ( ERCP ) and IDUS with definite diagnosis of cholangiocarcinoma from January 2012 to January 2017 were included in this retrospective study, and 59 patients undergoing ERCP and IDUS during the same period with definite diagnosis of benign bile duct stricture were included as control. Clinical data, indices of laboratory tests, and manifestations of IDUS ( including length of stricture, echo feature, thickness of bile duct, symmetry, and integrity of outer membrane of bile duct wall) were collected and compared between the two groups. Results The clinical manifestations and results of laboratory examination showed no significant differences between the two groups. Intraductal brushing cytology and forceps biopsy showed 28. 9％ and 40. 0％ malignant evidence respectively. IDUS showed thicker bile duct in the cholangiocarcinoma group (6. 8±4. 0 mm VS 4. 1±2. 3 mm, P<0. 01). Proportion of hypoechoic and nonsymmetrical thickened bile duct was higher in the cholangiocarcinoma group( 78. 8％ VS 44. 1％, 92. 3％ VS 50. 8％, respectively, all P<0. 01 ) . Outer membrane of bile duct destruction occurred in 8 cases ( 15. 4％) in the cholangiocarcinoma group, whereas none was seen in the control group. Conclusion Hypoecho and nonsymmetrical thickness on IDUS may be indicators of cholangiocarcinoma, and destruction of bile duct outer membrane is highly suggestive of cholangiocarcinoma.

Objective To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination.Methods Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study.The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group.Results A total of 34 cases were included with average age of (38.3± 8.9) years old.All EM lesions located within rectum and sigmoid colon.The endoscopic lesions manifested as protrusion in 21 cases (61.8％) and protrusion-depression in 13 cases (38.2％),local stenosis in 8 cases (23.5％);erosive surface in 33 cases (97.1％) with local spontaneous hemorrhage in 4 cases (11.8％);nodal surface in 23 cases (67.6％),and lymphangiectasis base in 9 cases (26.4％).Endoscopic biopsy specimens were obtained in all cases with average 3 (2,4) pieces.Positive results were found only in 4 patients (11.8％) with 3 endometriosis and one (endometrial) adenosarcoma.Compared with negative group,spontaneous hemorrhage was more frequent in positive group (2/4 vs.2/30,P=0.013).Mean biopsy sample number was significantly larger in positive group (5 vs.3,P=0.004).Conclusions Colorectal endometriosis is mostly located within rectosigmoid region.Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface,or local stenosis.Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy,thus increasing biopsy sample numbers may improve pathology results.

Objective To evaluate the efficacy, safety and risk factors of endoscopic treatment for patients with early gastric cancer. Methods A retrospective study was conducted in a single center and data was collected from 186 early gastric cancers in 168 pathologically confirmed patients who received endoscopic treatment in Peking Union Medical College Hospital from January 2006 to December 2015. The cases were divided into different groups according to indications of endoscopic treatment. The curative resection rate and complication rate were analyzed. Post-resection outcomes were evaluated by long-term surveillance. Results The curative resection rate was 86. 9%( 73/84) in the group with absolute indications, 61. 7%(50/81)in the group with expanded indications, and 33. 3%(7/21) in the group beyond indications (P＜0. 01). Multivariate analysis revealed that the significant independent predictors for curative resection included lower third location of stomach, no ulceration,≤2 cm at diameter, no adhesion, and well-differentiation in histopathology. In the expanded indications group, discordance of differentiation type and deeper invasion mainly resulted in non-curative resection in en bloc lesions. The rate of bleeding and perforation was 4. 8%( 9/186) and 3. 8%( 7/186), respectively. The perforation rate was significantly lower in the lesions located in the lower third of stomach, without adhesion or performed by en bloc resection. During a median follow-up period of 22. 3 months, 154 patients were followed successfully. The incidence of synchronous and metachronous gastric cancers in curative resected lesions was 7. 5%( 8/106) and 0. 9%(1/106), respectively. Conclusion Endoscopic resection is an optimal treatment with high curative resection rate for early gastric cancer patients with absolute indications. Patients with expanded indications should take precise preoperative evaluation to avoid higher risk of non-curative resection endoscopically. Close follow-up is necessary for synchronous and metachronous gastric cancers after endoscopic resection.