Objective To compare the effectiveness and safety of different intracranial stents assisted coil embolization of intracranial aneurysms and to discuss the selection of different stent assisted embolization of intracranial aneurysm.Methods From 2007 April to 2012 April,118 cases (a total of 128 wide-neck aneurysms) with intracranial aneurysms were analyzed retrospectively.This included the use of 70 neuroform,38 Enterprise,and 20 Solitaire AB stents forthe treatment of intracranial aneurysms.The successful use,aneurysm occlusion at the immediate post-operation,and early period of peri-operative complications were recorded from those clinical data in order to assess the effectiveness and safety of the different intracranial stents,which assisted coil embolization of intracranial aneurysms.Rank sum test and x2 test were used for statistics.Results Three aneurysms assisted with Neuroform stent were planted unsuccessfully,and the Enterprise and Solitaire stents were placed successfully.The embolism results of three stents after immediate postoperative angiography aneurysm: Neuroform stent occlusion rate was 40.0％ (28/ 70),the tumor residual rate was 38.6 ％ (27/70),and the partial embolization rate was 21.4 ％ (15/70) ; The Enterprise stent occlusion rate was 42.1％ (16/38),the tumor residual rate was 36.8 ％ (14/38),and the partial embolization rate was 21.1％ (8/38).The Solitaire AB stent occlusion rate was 40.0 ％ (8/20),the tumor residual rate was 35.0 ％ (7/20),and the partial embolization rate was 25.0 ％ (5/20).There were not significant differences in aneurismal occlusion (H =0.12,P ＞ 0.05).Early peri-operative complications results were: Neuroform stent occurred in 7,Enterprise frame in 4,and Solitaire AB stent occurred in 2.There were no significant differences in the incidence of complications in the early period after coiling (x2 =0,P ＞ 0.05).Conclusions Three kinds of intracranial stents assisted embolization of intracranial aneurysms are applied safely and effectively.The stent may be chosen according to morphology of parent artery and stent biological character.

Objective To evaluate and compare the clinical efficacy and safety of intense pulsed light (IPL) versus 595-nm pulsed dye laser (PDL) for the treatment of post-acne erythema.Methods A randomized split-face clinical trial was conducted.A total of 20 patients with post-acne erythema were enrolled,and randomized to receive treatment with IPL on one half of the face and 595-nm PDL on the other facial side once every 4 weeks for 3 sessions.Digital photographs were taken using the VISIA,and erythema index was recorded before each treatment and one month after the last treatment.The severity of bilateral facial erythema was evaluated based on a 4-point grading scale before the first treatment and after the last treatment.Pain scores and adverse reactions were recorded using a visual analogue scale (VAS) after each treatment,and a patient satisfaction survey was conducted by questionnaire at the last follow-up.Results The mean erythema index on the IPL side before and after treatment was 472.25 ± 86.02 and 357.15 ±82.71 respectively,and that on the PDL side before and after treatment was 476.40 ± 74.25 and 360.05 ± 64.83 respectively.Repeated measures analysis of variance (ANOVA) showed that the erythema indices on both treated sides significantly decreased over time (F =197.666,P ＜ 0.001),and the efficacy of IPL was better than that of PDL (F =1 173.909,P ＜ 0.001).Erythema severity grades on the IPL side as well as on the PDL side significantly differed between before and after treatment (Z =28.735,31.450,respectively,both P ＜ 0.001).As VAS showed,the pain score on the PDL side was significantly lower than that on the IPL side (t =2.468,P ＜ 0.05).Among the 20 patients,17 and 15 assessed their improvement as good or excellent after PDL and IPL treatment respectively,but there was no significant difference between the two groups (Z =2.696,P ＞ 0.05).The adverse reactions included erythema,burning sensation,tense sensation,blistering and hyperpigmentation on IPL-treated side,and erythema and purpuric reactions on the PDL-treated side,which all disappeared in a few hours to several days.Conclusions Both IPL and 595-nm PDL are effective and safe for the treatment of post-acne erythema,and are worthy of clinical promotion and application.IPL shows superiority in the efficacy,but elicits higher pain sensation compared with PDL.

OBJECTIVEThe history of clinical application of extracorporeal membrane oxygenation (ECMO) has been more than 30 years. But in China, there were only a few ECMO centers with limited successful cases reported by the end of twentieth century. The high morbidities and mortalities in current pediatric ECMO practice are noted in China. Therefore, it is necessary to review the experience on rescue use of ECMO in critically ill pediatric patients.

METHODA retrospective analysis was done for patients who had been receiving ECMO treatment to rescue refractory cardiorespiratory failure from different causes in a hospital between July 2007 and May 2011.

RESULTA total of 12 patients were treated with ECMO; 7 of them were male and 5 female, they aged 6 days to 11 years, weighed 2.8 - 35 (17.21 ± 11.64) kg. The underlying causes of cardiorespiratory failure were as follows: two cases with acute respiratory distress syndrome (ARDS) leading to respiratory failure, 4 with failure of weaning from cardiopulmonary bypass, 3 with fulminant myocarditis, 1 with right ventricular cardiomyopathy leading to repeated cardiac arrest, 1 with preoperative severe hypoxemia, and 1 with anaphylactic shock complicated with massive pulmonary hemorrhage and severe hypoxemia. Of the 12 cases, 3 were established ECMO (E-CPR) while underwent chest compression cardiopulmonary resuscitation (CPR). The mean ECMO support time was 151.75 (15 - 572) h. Seven patients (58.33%) were weaned from ECMO, 6 patients (50.00%) were successfully discharged. Six cases had bleeding from sutures, 2 cases with severe bleeding underwent thoracotomy hemostasis, 2 presented with acute renal failure. Infection was documented in 3 cases, hyperbilirubinemia in 2 cases, lower limb ischemia in 1 case, hyperglycemia in 3 cases, disseminated intravascular coagulation in 1 case, membrane lung leakage in 2 cases, systemic hemolysis in 3 cases, oxygenator failure in 2 cases and oxygenator thrombosis in one case. During the follow-up between 6 months and 4.5 years, 5 patients survived with good quality of life, without any documented central nervous system disorders. One case survived with the right lower extremity disorder from ischemic damage. His motor function has been improved following orthopedic operation at one year after discharge.

CONCLUSIONECMO is a justifiable alternative treatment for reversible severe cardiopulmonary failure in critically ill children.

Cardiac Output, Low ; etiology ; therapy ; Cause of Death ; Child ; Child, Preschool ; Critical Illness ; mortality ; therapy ; Extracorporeal Membrane Oxygenation ; adverse effects ; Female ; Heart Failure ; etiology ; mortality ; therapy ; Hemorrhage ; epidemiology ; etiology ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications ; mortality ; therapy ; Respiratory Insufficiency ; etiology ; mortality ; therapy ; Retrospective Studies ; Survival Analysis ; Thrombosis ; epidemiology ; etiology ; Treatment Outcome

Alanine Transaminase ; blood ; DNA, Viral ; blood ; Female ; Hepatitis B Antibodies ; blood ; Hepatitis B Surface Antigens ; blood ; Hepatitis B, Chronic ; virology ; Humans ; Male

Given that increased thermogenesis in white adipose tissue, also known as browning, promotes energy expenditure, significant efforts have been invested to determine the molecular factors involved in this process. Here we show that HOXC10, a homeobox domain-containing transcription factor expressed in subcutaneous white adipose tissue, is a suppressor of genes involved in browning white adipose tissue. Ectopic expression of HOXC10 in adipocytes suppresses brown fat genes, whereas the depletion of HOXC10 in adipocytes and myoblasts increases the expression of brown fat genes. The protein level of HOXC10 inversely correlates with brown fat genes in subcutaneous white adipose tissue of cold-exposed mice. Expression of HOXC10 in mice suppresses cold-induced browning in subcutaneous white adipose tissue and abolishes the beneficial effect of cold exposure on glucose clearance. HOXC10 exerts its effect, at least in part, by suppressing PRDM16 expression. The results support that HOXC10 is a key negative regulator of the process of browning in white adipose tissue.
Adipocytes ; Adipose Tissue, Brown ; Adipose Tissue, White ; Animals ; Ectopic Gene Expression ; Energy Metabolism ; Genes, Homeobox ; Glucose ; Mice ; Myoblasts ; Thermogenesis ; Transcription Factors

OBJECTIVETo evaluate the implication of Fletcher and Miettinen biologic potential grading criteria in native localized gastrointestinal stromal tumors (GISTs).

METHODSTwo hundred and twenty localized GISTs with complete clinicopathologic and follow-up data were evaluated for their biologic potential by Fletcher and Miettinen grading criteria. The implication of the two grading criteria were compared by survival analysis.

RESULTSEvaluated by Fletcher grading criteria, the overall and disease-free survival rate of high risk GISTs was lower than that of very-low, low and intermediate GISTs; while the overall and disease-free survival rate of very-low, low and intermediate risk GISTs had no statistical diffence. In the high risk GISTs, the overall and disease-free survival rate of small intestinal and rectal GISTs was lower than that of gastric GISTs; while in the intermediate risk GISTs, the disease-free survival rate of small intestinal GISTs was lower than that of gastric GISTs. Evaluated by Miettinen grading criteria, the overall and disease-free survival rate of high risk GISTs was lower than that of very-low, low and intermediate GISTs; while the overall and disease-free survival rate of very-low, low and intermediate risk GISTs had no statistical difference. In the risk subgroup of GISTs, the overall and disease-free survival rate of gastric, small intestinal and rectal GISTs had no statistical difference.

CONCLUSIONSFletcher grading criteria is simple and easy to use; while Miettinen grading criteria for evaluating biological potential by anatomic site is more critical and has important reference implication for the selection of high risk patients for targeted adjuvant treatment.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Disease Progression ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; pathology ; Humans ; Ileal Neoplasms ; pathology ; Jejunal Neoplasms ; pathology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Rectal Neoplasms ; pathology ; Risk Assessment ; methods ; standards ; Stomach Neoplasms ; pathology ; Survival Rate ; Young Adult

OBJECTIVETo determine the role of sphingosine 1-phosphate receptor (S1PRs ) signaling in CD34+ hematopoietic stem/progenitor cell transmigration.

METHODSCD34(+) cells were separated by Ficoll density gradient centrifugation and incubated in DMEM medium with 10% fetal calf serum. The cells were pretreated by FTY720, with or without pertussis toxin (PTX) and antiCXCR4 mAb in the medium, followed by addition of 100 ng/ml SDF-1 into the lower chamber of a Costar 24-well transwell. The migrated cells were counted using FACS and the migrating rates were determined. The expressions of sphingosine 1-phosphate receptors were analyzed in CD34(+) cells before and after the transmigration by reverse transcriptase- polymerase chain reaction (RT-PCR). Cord blood CD34(+) cells were treated with or without FTY720 (10(+) mol/L), and the expressions of CD49d (VLA-4), CD11a (LFA-1), and CD62L (L-selectin) were analyzed at 1, 8, and 16 h after the treatment.

RESULTSWhile FTY720 did not affect spontaneous migration, a substantial increase of SDF-1-induced transmigration was observed in the presence of FTY720 (15.26 2.14 to 28.64 2.37). The FTY720-enhanced transmigration was completely blocked by addition of PTX or antiCXCR4 mAb. S1p1-5 was expressed in fresh isolated cord blood CD34(+) cells. The migrating cells stimulated by FTY720 and SDF-1 only expressed S1P1, S1P3, and S1P4. The expressions of CD49d, CD11a and CD62L on CD34(+) cells treated with FTY720 remained unchanged at the selected time points as compared with the control.

CONCLUSIONSS1PRs are involved the transmigration of CD34(+) cells. The activation of S1PRs results in increased chemotactic response of CD34(+) to SDF-1. These effects are mediated through CXCR4 and PTX-sensitive Gi proteins. Only the CD34(+) cells expressing the specific receptors can rapidly transmigrate. The activation of the S1PRs does not affect the expressions of the adhesion molecules on cord blood CD34(+) cells.

Antigens, CD34 ; metabolism ; Cell Movement ; Cells, Cultured ; Chemokine CXCL12 ; pharmacology ; Fetal Blood ; cytology ; Fingolimod Hydrochloride ; Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cells ; cytology ; drug effects ; Humans ; Propylene Glycols ; pharmacology ; Receptors, Lysosphingolipid ; metabolism ; physiology ; Signal Transduction ; Sphingosine ; analogs & derivatives ; pharmacology

BACKGROUNDAccording to the National Institutes of Health consensus criteria, gastrointestinal stromal tumors (GISTs) smaller than 2 cm in diameter with less than 5 mitotic figures per 50 high-power fields are considered very-low-risk GISTs, but these two indices alone cannot reliably predict a benign outcome during long-term follow-ups. Therefore, identification of additional parameters for predicting the clinical behavior of GISTs is necessary.

METHODSEighty-eight patients with tumors that meet the very-low-risk GIST criteria were retrospectively investigated and morphological parameters of tumors associated with the biological behavior of very-low-risk GISTs were evaluated in the present study. The Kaplan-Meier method was used to calculate disease-free survival rates.

RESULTSEighty-one patients were followed up for one to 16.3 years. Five cases of relapses were identified in the patients. Distinctive infiltrative growth patterns such as muscularis propria, muscularis mucosa, or nerve infiltration were identified by microscopy in 4 patients with the relapse, including three patients who experienced multiple recurrences. The infiltrative growth features became more obvious in multiple recurrent tumors compared to the single recurrent tumor, while only one developed relapse in 76 patients without infiltration (P < 0.0001).

CONCLUSIONMicroscopic infiltrative growth patterns of the tumor may have clinical significance in predicting the prognosis of very-low-risk GISTs.

Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Gastrointestinal Stromal Tumors ; pathology ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

OBJECTIVETo explore the origin and differentiation of gastrointestinal stromal tumors (GISTs).

METHODSImmunohistochemistry staining and electron microscopy were adopted.

RESULTSIn 212 cases of primary GISTs, the positive rates of CD117, CD34, alpha-SMA, MSA, desmin, S-100, PGP9.5 were 96.7%, 77.3%, 19.3%, 15.6%, 1.9%, 16.3%, and 12.3% respectively. Among them, GISTs showed a diffuse and strong positivity for CD117. Electron microscopy of tumor cells demonstrated numerous mitochondria, prominent perinuclear Golgi complex, smooth and rough endoplasmical reticulum and intermediate filaments. Irregular caveolae, dense plaque, incontinuous basal lamina were observed occasionally. Cytoplasmic processes were often observed accompanying with local adhesion present between the processes or between the processes and the cell membrane.

CONCLUSIONSData from both immunophenotype and electron microscopy suggest that GIST might originate from the mesenchymal cells, differentiating to be ICC afterwards, and possessing myoid characteristics in various extent.

Cell Differentiation ; Gastrointestinal Stromal Tumors ; chemistry ; ultrastructure ; Golgi Apparatus ; ultrastructure ; Humans ; Immunohistochemistry ; Microscopy, Electron ; Proto-Oncogene Proteins c-kit ; analysis ; S100 Proteins ; analysis ; Stromal Cells ; chemistry ; ultrastructure ; Ubiquitin Thiolesterase ; analysis

OBJECTIVETo investigate the clinical stage and histological grade of gastrointestinal stromal tumors.

METHODSTwelve clinical and pathological parameters were assessed in 613 patients with follow-up information. These parameters were classified into two gross spread parameters including liver metastasis and peritoneal dissemination, five microscopic spread parameters including lymph node metastasis, vascular, fat, nerve and mucosal infiltration, and five histological parameters including mitotic count ≥ 10 per 50 high-power fields, muscularis propria infiltration, coagulative necrosis, perivascular pattern and severe nuclear atypia.

RESULTSThe accumulated 5-year disease-free survival (DFS) and overall survival (OS) of 293 patients without any of these predictive parameters of malignancy were 99.3% and 100.0%, respectively. They were regarded as nonmalignant and further evaluations on the stage and grade of these tumors were not performed. At least one and at most seven predictive parameters of malignancy were identified in 320 patients. For these patients, the accumulated 5-year DFS and OS rates were 43.9% (mean 6.7 years) and 59.7% (mean 9.3 years), respectively. The DFS showed significant difference between patients with and without gross spread (P < 0.01), with and without microscopic spread (P = 0.001). DFS and OS were associated with the number of predictive parameters of malignancy in patients without gross spread (P < 0.01 for both DFS and OS), but not in patients with gross spread (P = 0.882 and 0.441, respectively).

CONCLUSIONSMalignant GIST could be divided into clinical stages I and II based on the absence and presence of gross spread, respectively. The degree of malignancy of patients in clinical stage I could be graded according to the number of predictive parameters of malignancy. Patients in clinical stage II were of the highest degree of malignancy regardless of the number of parameters. The staging and grading of gastrointestinal stromal tumors in this study are strongly associated with prognosis.

Actins ; metabolism ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antigens, CD34 ; metabolism ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; metabolism ; pathology ; surgery ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; methods ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; Proto-Oncogene Proteins c-kit ; metabolism ; Survival Rate ; Young Adult