Abstract: Objective To detect the polymorphisms of drug resistance-related genes pvcrt-o and pvmdr1 of Plasmodium vivax in lazan city in the China-Myanmar border, in order to guide the treatment plan of Plasmodium vivax. Methods A total of 48 Plasmodium vivax samples were collected from Lazan in the China-Myanmar border in 2007, and fragments of pvcrt-o and pvmdr1 genes were amplified by PCR and sequenced. The sequences were aligned with the Salvador I (Sal-I) strain reference genome sequences to determine the presence of SNPs. Results The target fragments of pvcrt-o gene were amplified from 39 Plasmodium vivax samples, while pvmdr1 genes were amplified from 40 samples. Amongst them, 25 samples had AAG insertion before the 10th amino acid (K10 insertion) of pvcrt-o gene, accounting for 64.1%. Non-synonymous mutations were detected at three loci of pvmdr1 gene (T958M, Y976F, and F1076L), the mutation rates were 100%, 22.5%, and 55.0%, respectively. There were three haplotypes of pvmdr1 gene, of which the triple mutant 958M/976F/1076L accounted for 22.5% (9/40), the double mutant 958M/Y976/1076L accounted for 32.5% (13/40), and the single mutant 958M/Y976/F1076 accounted for 45.0% (18/40). The proportion of strains with pvcrt-o and pvmdr1 gene mutation is 63.16%, which is significantly different from those only with pvmdr1 mutation. Conclusions The proportion of pvcrt-o and pvmdr1 gene mutation of 48 Plasmodium vivax isolates is high in the China-Myanmar border, and there is a certain degree of correlation between the two gene mutations. To assess changes in Plasmodium vivax drug resistance in this region, it is required to improve the surveillance of these two molecular markers.

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.
Adult ; Aged ; Biopsy, Large-Core Needle ; Female ; Humans ; Image-Guided Biopsy ; Lymphoma/diagnostic imaging* ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule ; Ultrasonography, Interventional

Common bile duct (CBD) stones are a frequent problem in Chinese populations, and their incidence is particularly high in certain areas (Wang et al., 2013). In recent years, laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) have been the main surgical procedures for CBD stones, although each has different advantages and disadvantages in the treatment of choledocholithiasis (Loor et al., 2017; Zhou et al., 2017). For patients with large stones, a dilated CBD, especially concurrent gallstones, LCBDE is the preferred and most economical minimally invasive procedure (Koc et al., 2013). However, a T-tube is often placed during LCBDE to prevent postoperative bile leakage; this is associated with problems such as bile loss, electrolyte disturbance, and decreased gastric intake (Martin et al., 1998). In addition, the T-tube usually must remain in place for more than a month, during which time the patient's quality of life is seriously compromised. Many skilled surgeons currently perform primary closure of the CBD following LCBDE, which effectively speeds up rehabilitation (Hua et al., 2015). However, even in sophisticated medical centers, the incidence of postoperative bile leakage still reaches ≥10% (Liu et al., 2017). Especially for a beginner, bile leakage remains a key problem (Kemp Bohan et al., 2017). Therefore, a safe and effective minimally invasive surgical approach to preventing bile leakage during primary closure of the CBD after LCBDE is still urgently needed.
Aged ; Aged, 80 and over ; Choledocholithiasis ; Common Bile Duct Diseases ; Drainage/methods* ; Female ; Gallstones ; Gastroscopy ; Humans ; Laparoscopy ; Male ; Middle Aged

OBJECTIVETo analyze the prognostic factors of pancreatic neuroendocrine neoplasms (PNEN).

METHODSClinical data of 61 patients with PNEN from March 1992 to December 2012 was retrospectively analyzed. There were 23 male and 38 female patients, with a median age of 52 years (ranged from 22 to 68 years). Forty-one patients were non-functional tumors, and 20 patients were functional tumors. Fifty-nine patients received operation, 13 (22.0%) patients underwent laparoscopic operation, 2 patients underwent puncture biopsy under CT guidance. Survival was analyzed with the Kaplan-Meier method.

RESULTSAmong these patients, 53 (86.9%) patients underwent curative resection. The cases of grade G1, G2, G3 were 41 (67.2%), 9 (14.8%), 11 (18.0%), respectively. The cases of stageI, II, III, IV were 47 (77.0%), 7 (11.5%), 2 (3.3%), 5 (8.2%), respectively. Liver metastasis, neural invasion were found in 5 cases (8.2%), 5 cases (8.2%), respectively. The median follow-up period was 40 months (ranged from 3 to 209 months). The overall 1-, 3-, 5-year survival rates were 92.0%, 89.7%, 86.3%, respectively. Univariate analysis showed WHO classification (χ(2) = 18.503), TNM staging system (χ(2) = 23.401), liver metastasis (χ(2) = 18.606), neural invasion (χ(2) = 10.091), resection status (χ(2) = 25.514) were prognostic factors of PNEN (all P = 0.000).

CONCLUSIONSSurgical resection in PNEN results in long-term survival. WHO classification, TNM staging, resection status are effective in predicting the prognosis of PNEN. Liver metastasis, neural invasion predicted poor prognosis.

Humans ; Neoplasm Staging ; Pancreatectomy ; Pancreatic Neoplasms ; surgery ; Prognosis ; Survival Rate

BACKGROUNDLaparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis.

METHODSThe Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status.

RESULTSSix studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = -27.97 min, 95% confidence interval [CI]: -49.40--6.54, P < 0.01); less intraoperative blood loss (WMD = -0.72 ml; 95% CI: -1.30--0.13, P = 0.02); earlier time to flatus (WMD = -0.83 day; 95% CI: -1.44--0.22, P < 0.01); earlier time to restart oral intake (WMD = -1.95 days; 95% CI: -3.31--0.60, P < 0.01); shorter hospital stay (WMD = -3.00 days; 95% CI: -4.87--1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33-0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients.

CONCLUSIONSLAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.

Objective To investigate the effects of 654-2 acupoint injection at Zusanli combined with shiatsu at Neiguan acupoint for colonoscopy analgesia. Methods Totally 140 patients underwent colonoscopy were divided into observation group and control group according to the random number table method, with 70 cases in each group. The observation group were given 654-2 acupoint injection at Zusanli (5 mg each side) combined with shiatsu at Neiguan acupoint (the patient to feel the acid, swelling, hemp began to check, until colonoscopy to return to the ileocecum, stop pressing), and the control group were given 654-2 muscle injection (10 mg) 10 min before colonoscopy. The pain scores, checking time and patients'' satisfaction degree of the two groups were compared, and serum beta-endorphin (β-EP) and substance P (SP) level of the two groups before and after examination were compared. Results The pain degrees during colonlscope inserting and passing the sigmoid, splenic flexure of colon of the observation group were significantly lower than those of the control group (P<0.001); testing time was less than that of the control group (P<0.001); patient satisfaction scores were higher than those of the control group (P<0.001); serum β-EP level after examination was higher than that of the control group (P<0.001); SP level was lower than that of the control group (P<0.001). Conclusion 654-2 acupoint injection at Zusanli combined with shiatsu at Neiguan acupoint for colonoscopy analgesia can adjust the serum levels of β-EP and SP, with obvious analgesic effect, which can shorten the testing time.

OBJECTIVETo explore the effect of arsenic trioxide (As2O3) on the growth inhibition of imatinib (IM)-resistant bcr-abl mutant cell lines in vitro.

METHODSCell growth of one IM-sensitive cell line, 32Dp210 and 15 IM-resistant cell lines including T315I and other 14 bcr-abl mutants were detected by MTT assay after treatment with IM and As2O3. The cell lines with 5 frequently observed mutants in CML patients were analyzed for apoptosis by flow cytometry with Annexin V and PI staining as well as the expression of bcr-abl fusion protein, phosphorylated CRKL protein and apoptosis-related proteins by Western blot.

RESULTSThe fifty percent inhibition concentration (IC50) values of As2O3 for 15 IM-resistant cell lines were 2.6-5.3 fold lower than that for IM-sensitive cell line. For the 5 bcr-abl mutants frequently happened in CML patients, As2O3 significantly inhibited the expression of bcr-abl fusion protein and phosphorylated CRKL and induced apoptosis in a dose-dependent manner as compared with that for 32Dp210. Coincidently, the cell apoptosis was induced through caspase-3, 8 and 9 pathways.

CONCLUSIONAs2O3 remarkably inhibits cell growth and induces apoptosis of IM-resistant bcr-abl mutant cell lines in vitro, suggesting that it might be a potential therapeutic agent for IM-resistant CML patients.

Adaptor Proteins, Signal Transducing ; metabolism ; Apoptosis ; drug effects ; Arsenicals ; pharmacology ; Benzamides ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Drug Resistance, Neoplasm ; Fusion Proteins, bcr-abl ; genetics ; metabolism ; Humans ; Imatinib Mesylate ; Mutation ; Nuclear Proteins ; metabolism ; Oxides ; pharmacology ; Piperazines ; pharmacology ; Pyrimidines ; pharmacology

OBJECTIVETo study the clinical features of hepatitis-associated aplastic anemia (HAAA) in children.

METHODSThe clinical data of the children with newly diagnosed HAAA from January 2007 to December 2008 were respectively studied, including clinical manifestations, and blood routine, bone marrow examination, viral serology and immune function results as well as treatment and prognosis.

RESULTSA total of 8 children were confirmed as HAAA, accounting for 4.9% in children with aplastic anemia. There were 7 males and 1 female. The median age was 7.5 years (range 4.4 to 10.3 years) at diagnosis. They had negative serologic results and the causes of hepatitis could not be identified. The median interval from hepatitis occurrence to blood cell reduction was 6 weeks. Three cases were diagnosed as severe aplastic anemia and 5 cases as very severe aplastic anemia. Severe T cell immune disorders were found in all 8 cases. The percentage of Ts cells increased and the percentage of Th cells decreased significantly in the 8 children with HAAA. Four children survived after immune suppress treatment, three children died within one month after diagnosis and one child required own discharge without treatment.

CONCLUSIONSHAAA is more frequent in male school children. The children with HAAA have severe T cell immune disorders, with a higher early death rate. Immune suppress treatment is effective.

Anemia, Aplastic ; etiology ; immunology ; therapy ; Child ; Child, Preschool ; Female ; Hepatitis ; complications ; Humans ; Male ; Prognosis

Objective To analyze the time trend of HIV epidemic and to provide basis for comprehensive HIV infection prevention among pregnant women. Methods From 2014 to 2018, continuous cross-sectional surveys were conducted among pregnant women in two maternity and child health care hospitals. 800 blood samples were collected each year to test HIV infection, syphilis and hepatitis C virus (HCV). Results A total of 4 000 eligible pregnant women completed the interview and blood testing. The awareness rate of knowledge about HIV/AIDS was 91.2%, and the rate was increasing year by year. Multivariate Logistic regression analysis showed that the awareness rate was associated with at age of more than 35, with lower education than college and the husband used to work in other places. Conclusions The rate of HIV infection among PRGs was at a low level in Taizhou.

OBJECTIVETo introduce the Item Function Analysis(IFA) of Quality of Life- Alzheimer's disease(QOL-AD)Chinese version and to explore the feasibility of its application on Chinese patients with AD.

METHODSTwo hundred AD patients were interviewed and assessed by QOL-AD, through the stratified cluster sampling method. Multilog 7.03. was used for Item Function Analysis. Difference scale(a), difficulty scale(b)and Item Characteristic Curve(ICC) of each item of QOL-AD were provided.

RESULTSDifferent scales of the item 1, 7 were below 0.6, while all the others were above 0.6. As for ICC. The first and last lines for the other items were monotonic in which the two in between were in inverted V-shape, with very steep slopes, except for the item 1 and 7.

CONCLUSIONResults form the IFA showed that QOL-AD was applicable to be used in the Chinese patients with AD.

Aged ; Aged, 80 and over ; Alzheimer Disease ; psychology ; Asian Continental Ancestry Group ; genetics ; Humans ; Psychometrics ; methods ; Quality of Life