OBJECTIVETo observe clinical therapeutic effects of acupuncture combined with medication in restoration of gastrointestinal functions for postoperative patients with gastric cancer.

METHODSNinety patients undergoing radical surgeries for gastric cancer were randomly, according to the sequence of their operations, divided into three groups: a control group treated conventionally after their surgeries (group CONT, 30 cases), a Chinese medicine group treated by Simo Decoction administered by way of a nutrient canal in addition to the conventional treatment (group CM, 30 cases), and an acupuncture plus Chinese medicine group treated by warming needling in addition to those given in the Chinese medicine group (group ACUP+CM, 30 cases). Therapeutic effects were estimated 10 days after their operations.

RESULTSThe time for restoration of gastrointestinal functions was obviously shortened, and the problems of poor appetite and difficulty in defecation were more markedly improved in group ACUP+CM than those in both group CONT and group CM (P < 0.01, P < 0.05). Ten days after operations, the number of patients with normal lymphocytes and normal percentage rate of lymphocytes to neutrophile granulocytes was obviously more in group ACUP+CM than those in both group CONT and group CM (P < 0.01, P < 0.05).

CONCLUSIONAcupuncture combined with Chinese medicine is favorable in accelerating early air exhaustion and defecation, improving clinical symptoms, as well as in bi-directional regulating peripheral white blood cells.

Acupuncture Therapy ; methods ; Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Postoperative Care ; methods ; Recovery of Function ; Stomach Neoplasms ; physiopathology ; surgery ; therapy ; Time Factors ; Treatment Outcome

OBJECTIVETo study the diagnostic usefulness of immunohistochemical markers in distinguishing between invasive ductal carcinoma and invasive lobular carcinoma of breast.

METHODSTwenty-four cases of grade I invasive ductal carcinoma, 12 cases of classic invasive lobular carcinoma and 14 cases of invasive carcinoma with mixed ductal and lobular features were retrieved from the archival files of Peking University First Hospital during the period from January, 1998 to December, 2001. Immunohistochemical study for E-cadherin, p120 catenin, epithelia membrane protein 1 (EMP1) and DVL1 was performed.

RESULTSThe positivity rates for E-cadherin in grade I invasive ductal carcinoma and classic invasive lobular carcinoma were 83.3% (20/24) and 0, respectively (P < 0.01). The positivity rates for p120 catenin were 100% in both grade 1 invasive ductal carcinoma (membranous staining) and classic invasive lobular carcinoma (cytoplasmic staining). The positivity rates for EMP1 and DVL1 in gradeI invasive ductal carcinoma were 95.8% (23/24) and 54.2% (13/24), respectively; while those in classic invasive lobular carcinoma were 12 and 5 cases, respectively.

CONCLUSIONSE-cadherin and p120 catenin are useful immunomarkers for distinguishing between invasive ductal carcinoma and invasive lobular carcinoma. On the other hand, EMP1 and DVL1 are of limited value in this respect.

Adaptor Proteins, Signal Transducing ; metabolism ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Cadherins ; metabolism ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; surgery ; Carcinoma, Lobular ; metabolism ; pathology ; surgery ; Catenins ; metabolism ; Diagnosis, Differential ; Disease-Free Survival ; Dishevelled Proteins ; Female ; Humans ; Mastectomy ; methods ; Middle Aged ; Neoplasm Proteins ; metabolism ; Phosphoproteins ; metabolism ; Receptors, Cell Surface ; metabolism ; Survival Rate

Background:The results of the Trial Assigning IndividuaLized Options for Treatment (TAILORx) suggested that approximately 70％ of T1-2N0M0,hormone receptor-positive,human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients can avoid chemotherapy and receive only adjuvant endocrine therapy.We conducted a retrospective analysis of the clinicopathologic features and prognostic factors of patients with breast cancer who met the inclusion criteria of the TAILORx trial.Methods:According to the enrollment criteria of the TAILORx trial,a retrospective analysis was performed on patients with breast cancer who were treated from January 2008 to December 2015 at Peking University First Hospital.The clinicopathologic characteristics of all patients were analyzed,and prognoses were calculated using the Kaplan-Meier method and a Cox proportionate hazards model.Results:A total of 2430 patients with early stage breast cancer who were admitted at our hospital had complete clinicopathologic data and follow-up information.Of these patients,722 met the inclusion criteria and were enrolled in the present study,accounting for 29.7％ of all patients.Among them,417 (57.8％) patients received only adjuvant endocrine therapy (the non-chemo group),and 305 (42.2％) patients received adjuvant chemotherapy followed by adjuvant endocrine therapy (the chemo group).No statistically significant difference was observed in overall survival (OS) between the two groups (non-chemo vs.chemo:5-year OS:97.9％ vs.97.9％,x2=1.00,P =0.995;hazard ratio [HR] =1.00,95％ confidence interval [CI]:0.46-2.21).A significant difference was observed in disease-free survival (DFS) between the two groups (non-chemo vs.chemo:5-year DFS:97.9％ vs.94.7％,x2 =8.65,P =0.003;HR =3.05,95％ CI:1.40-6.67).The choice of adjuvant therapy was associated with clinicopathologic factors,such as the age at diagnosis,T stage,histologic grade,the Ki67 index,the presence of intravascular tumor thrombus (P ＜ 0.001),pathologic type,and menstrual status (P =0.014).Conclusions:In the absence of internationally recognized multigene testing methods,for patients with early hormone receptorpositive,HER2-negative breast cancer,clinicians can develop a treatment plan based on clinicopathologic features only,which can effectively screen some patients who do not need adjuvant chemotherapy.However,nearly half of patients still receive adjuvant chemotherapy,and whether these patients can be exempted from chemotherapy warrants further exploration.

Objective To clone and express a high mobility group box 1(HMGB1)protein of Schistosoma japonicum(Main-land strain)and analyze its function. Methods The DNA fragment of open reading frame encoding Sj HMGB1 protein was ampli-fied by RT-PCR from the mRNA of S. japonicum worms,then it was subcloned into the expression vector pET28a(+)to form the recombinant expression plasmid SjHMGB1-pET28a. The recombinant expression plasmid was transformed into the component E. coli BL21(DE3),and the tranformant containing recombinant expression plasmid was induced with IPTG to express the recombi-nant protein SjHMGB1. The recombinant SjHMGB1 protein was purified by affinity chromatography with nickel chelating affinity chromatography agarose gel. The Gel retard experiment and animal immunization were performed to analyze the DNA binding ca- pacity and the immunologic property of recombinant SjHMGB1. The expression levels of HMGB1 in different life cycle stages of S. japonicum were analyzed by Western bloting and RT-PCR. Female ICR mice were immunized with the recombinant SjHMGB1 pro-tein and infected with 45±2 cercariae of S. japonicum after three immunizations. Forty-two days post-infection,the worms and eggs of S. japonicum were recovered from the portal vein and liver tissue,respectively. The worm and egg reduction rates were calculat-ed respectively. Results A 530 bp of specific DNA fragment was amplified from mRNA of S. japonicum by RT-PCR,which was the open reading frame(ORF)encoding SjHMGB1protein confirmed by DNA sequencing analysis. The recombinant expression plasmid SjHMGB1-pET28a was constructed by cloning the ORF of SjHMGB1 into a expression vector pET28a(+). The bacterium transformants containing the recombinant plasmid expressed a soluble recombinant protein about 28 kDa after induced by IPTG, and the recombinant SjHMGB1 protein was purified by nickel chelating affinity chromatography. The gel retard experiment showed that the recombinant SjHMGB1 protein could bind to both supercoiled DNA and linear DNA,and the recombinant protein immu-nized mice produced high titers of antiserum IgG. Western bloting indicated that the recombinant SjHMGB1 protein was recognized specifically by the S. japonicum-infected mice serum. Above results showed that the recombinant SjHMGB1 protein possessed both functional activity and immunogenicity as the natural protein. RT-PCR and Western blot results showed that SjHMGB1 was abun-dantly expressed in the adult and egg stages whereas barely detectable in the cercaria stage. The immune protection experiment showed that the recombinant SjHMGB1 induced mice to produce high titers of specific antibody IgG but failed to conduct an effec-tive immune protection against S. japonicum. Conclusion The gene encoding HMGB1 from S. japonicum and the soluble recombi-nant SjHMGB1 protein with natural functional activity are obtained,and the recombinant SjHMGB1 has a high immunogenicity but is not able to induce an effective immune protection against S. japonicum.

OBJECTIVETo investigate the influential factors of total blood loss during unilateral artificial total hip arthroplasty (THA).

METHODSFrom January 2014 to July 2016, 131 patients undergwent primary unilateral total hip arthroplasty, including 55 males and 76 females, ranging in age from 40 to 89 years old, with an average of 64.5 years old. The data of patients with unilateral total hip arthroplasty were collected, and the data of hemodynamics, coagulation function, hemoglobin and hematocrit values were recorded according to the observation data. The blood loss of the patients was calculated by Gross equation, and the data were analyzed by a statistical software.

RESULTSThe total blood loss of the patients was significantly affected by the factors of pathogenesis and deep venous thrombosis of the lower limbs. The results were statistically significant(<0.05). The gender, age, body mass index, prosthesis and anesthesia had little effects on the blood loss volume after replacement.

CONCLUSIONSThe data in this study indicate that the volume of actual blood loss can be controlled by adjusting non-surgical factors such as gender, age, body mass index, prosthetic material, and risk factors, and surgical factors(postoperative complications, anesthesia).

Objective:To investigate the effects of Sevoflurane on inflammatory response,neuro damage and the prognosis on surgery patients with traumatic brain injury ( TBI ) . Methods:From July 2015 to December 2016, 80 TBI patients undergoing neurosurgery were randomly divided into experimental group ( Sevoflurane treatment, n=40 ) and control group ( n=40 ) . The serum levels of TNF-α,IL-6,C-reactive protein ( CRP) and neuron specific enolase ( NSE) were tested with enzyme linked immunosorbent Assay (ELISA). GCS score,APACHEⅡ score and prognosises of the two groups were also compared. Results:Compared with control group,the serum levels of inflammatory related factors (CRP,TNF-α,IL-6) in the experimental group were significantly decreased in 1 hour of intraoperative,at the end of surgery and on 1st day after surgery respectively ( P<0. 05 or 0. 01 ) . Meanwhile, NSE protein expressions were significantly decreased(P<0. 05 or 0. 01). The experimental group received better prognosis compared to the control group,GCS scores[(10. 82±1. 40) vs (8. 29±1. 02),P=0. 03],APACHEⅡ scores[(14. 42±1. 97) vs (18. 03±2. 15),P=0. 02]on the 14th day. Conclusion:Sevoflurane treatment can effectively regulate the inflammatory response, reduce the neurons damage in surgery patients with TBI,possibly playing brain protection effect.

Objective:To observe the clinical efficacy of fire-needle therapy in treating deglutition disorders due to pseudobulbar palsy in the remission stage of stroke.Methods:Sixty-two eligible subjects were divided into a fire-needle group and a rehabilitation group by a simple randomization method at a ratio of 1:1.The two groups received same basic intervention;in addition,the fire-needle group received fire-needle treatment,while the rehabilitation group received rehabilitation training.The two groups of subjects all received a 3-week treatment and were evaluated by the dysphagia severity rating scale (DSRS),modified Mann assessment of swallow ability (MMASA) and Kubota Toshio swallow test (KTST) before and after the intervention.The complications and adverse events occurred during the trial were recorded.The data were statistically analyzed.Results:At the third week,the DSRS,MMASA and KTST scores changed significantly compared with the baseline in both groups (P＜0.05),and the changes in the fire-needle group were more significant than those in the rehabilitation group (P＜0.05).The between-group comparison at the third week showed that the therapeutic efficacy in the fire-needle group was superior to that in the rehabilitation group (P＜0.05).Conclusion:Fire-needle therapy can obviously change the DSRS,MMASA and KTST scores in pseudobulbar palsy in the remission stage of stroke,and significantly enhance the therapeutic efficacy of the treatment of deglutition disorders in this stage.

Objective To evaluate the segmental myocardium of left ventricular wall in patients with myocardial hypertrophic cardiomyopathy (HCM) by TDI-Q, explore whether the segmental myocardium contractile function is changed or not and determine the myocardial mechanics parameters variation. Methods Thirty-two healthy volunteers and twenty-one patients with hypertrophic cardiomyopathy were included and the standard dynamic two-dimensional tissue Doppler imaging (TDI) of mitral, papillary muscle and apical short axis view were collected in three consecutive cardiac cycles. The mechanical parameters variation and characteristics of systolic radial peak displacement (RD) and time to peak in left ventricle subendocardial, mid-myocardium and epicardial myocardium at different level and segment were analyzed.Results In healthy control group, at left ventricular basal, apical and papillary muscle level, there was no significant difference for time to peak and systolic radial peak displacement (F=0.74, 1.28 and 1.79, all P>0.05). In patients with HCM, time to peak of systolic RD at left ventricular different level was asynchronous. Time to peak of RD in septum at papillary muscle levels and apical lateral wall were longer than those of other segments. In healthy control group, except for apical inferior and lateral wall, RD of subendocardial myocardium was significantly greater than that of epicardial myocardium at different segments (t=-1.903, 4.574,-3.552,-2.614,-1.728,-1.790,-1.836,-2.794 and 2.733, all P<0.05 ). In patients with HCM, RD of subendocardial myocardium was significantly greater than that of epicardial myocardium in posterior wall, septum at basal level and in inferior wall, posterior wall and lateral wall at papillary muscle level (t=-2.305,-2.148, 3.550,-1.182 and-3.602, all P < 0.05). At the same segment, transmural RD of subendocardial and subepicardial myocardium in healthy subjects were greater than that in patients with HCM. In inferior wall, posterior wall, lateral wall and septum at basal level, in inferior wall, posterior wall and septum at papillary muscle level, and in lateral wall and septum at apical level, differences of transmural RD were statistically significant (t=-3.787,-2.983,-4.325,-6.972,-2.352, 2.823,-3.274,-1.338 and-2.857, all P<0.05). Conclusions In patients with HCM, synchrony of left ventricular motion at different level was abnormal and transmural RD of endocardial and epicardial myocardium was decreased, which suggested regional systolic dysfunction. Ultrasound assessment of left ventricular segmental transmural mechanics can further reveal left ventricular mechanical characteristics in patients with hypertrophic cardiomyopathy.

Background::After neoadjuvant chemotherapy (NAC), non-pathological complete response of breast cancer patients can benefit from tailored adjuvant chemotherapy. However, it is difficult to select patients with poorer prognosis for additional adjuvant chemotherapy to maximize the benefits. Our study aimed to explore whether the subtypes of tumor-infiltrating lymphocytes (TILs) in residual tumors (RT) is related to the prognosis of triple-negative breast cancer (TNBC) after NAC.Methods::Data from patients with primary TNBC consecutively diagnosed at the Breast Disease Center of Peking University First Hospital from 2008 to 2014 were retrieved, and the cases with RT in the breast after NAC were enrolled. TILs subtypes in RT were observed by double-staining immunohistochemistry, and counted with the median TILs value per square millimeter as the cut-off to define high versus low TILs density in each subtype. The relationships between the TIL density of each subgroup and the clinicopathological characteristics of the RT after NAC patients were analyzed by Fisher exact test. Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method and log-rank statistics.Results::A total of 37 eligible patients were included in this study, and the median follow-up period was 50 months (range 17–106 months). There was no significant correlation between the infiltrate density of CD4 +, CD8 +, CD20 +, and CD68 + lymphocytes and clinic-pathological characteristics. Significantly better prognosis was observed in patients with high CD4 +-TILs (DFS: P = 0.005, OS: P = 0.021) and high CD8 +-TILs (DFS: P = 0.018) and low CD20 +-TILs (OS: P = 0.042). Further analysis showed that patients with CD4 +/CD20 + ratio greater than 1 (DFS: P = 0.001, OS: P = 0.002) or CD8 +/CD20 + ratio greater than 1 (DFS: P = 0.009, OS: P = 0.022) had a better prognosis. Conclusions::Subtypes of TILs in RT is a potential predictive biomarker of survival in TNBC patients after NAC.

BACKGROUNDType 2 diabetes mellitus (T2DM) has traditionally been considered to affect mainly the elderly; however, the age at diagnosis has gradually reduced in recent years. Although the incidence of young-onset T2DM is increasing, it is still not fully clear the onset characteristics and risk factors of early-onset T2DM. The aim of this study was to describe the initiating characteristics of early-onset T2DM in Chinese patients and evaluate the risk factors for diabetes mellitus.

METHODSThis cross-sectional controlled study was performed using a questionnaire survey method in outpatients of multiple centers in China. A total of 1545 patients with T2DM with an age at onset of <40 years were included, and the control group consisted of subjects aged <40 years with normal blood glucose level.

RESULTSIn patients with young-onset T2DM, the mean age and initial hemoglobin 1Ac at diagnosis were 32.96 ± 5.40 years and 9.59 ± 2.71%, respectively. Most of the patients were obese, followed irregular diet pattern and sedentary lifestyle, had life or work pressure, and had a family history of diabetes mellitus. Compared with subjects with normal blood glucose level, logistic regression analysis showed that waist-to-hip ratio (odds ratio [OR] 446.99, 95% confidence interval [CI] 42.37-4714.87), family history of diabetes mellitus (OR 23.46, CI 14.47-38.03), dyslipidemia (OR 2.65, CI 1.54-4.56), diastolic blood pressure (OR 1.02, CI 1.00-1.04), and body mass index (OR 0.95, CI 0.92-0.99) are independent factors for early-onset T2DM.

CONCLUSIONSWe observed that abdominal obesity, family history of diabetes mellitus, and medical history of hypertension and dyslipidemia are independent risk factors for early-onset T2DM. It is, therefore, necessary to apply early lifestyle intervention in young people with risk of diabetes mellitus.

Adult ; Blood Glucose ; analysis ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; blood ; etiology ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Male ; Risk Factors ; Waist-Hip Ratio