Lynch syndrome.(LS) is an autosomal dominant condition caused by a mutation in the mismatch repair genes (MMR).Endometrial cancer (EC) is the most common extra-colonic cancers of LS Ⅱ type.Among the female members of LS family with the MMR gene mutation,EC has an overall lifetime risk more than 35％.LS-associated EC is more likely present as the clinical pathological characteristics of early age of onset,endometrioid adenocarcinoma,lower grade,lower uterine segment involvement,and better prognosis.LS patients with family history and early age of onset should be performed with a combined screening and genetic testing,while high-risk patients should be taken clinical monitoring methods as endometrial biopsy.Oral contraceptives mav be reasonable chemopreventive agents in the patients with LS.Although prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy to prevent EC in women with LS,preoperative counseling should address the trade-offs between the reduction in the risk of cancer,and the risks and side effects of surgery.The patients need hormone replacement therapy after surgery.

Aconitum, as a kind of common traditional Chinese medicine, contains multiple biological active substances, with a very high medicinal value but high toxicity. Its major toxic ingredients are aconitine, mesaconitine and hypaconitine, which are also efficient ingredients. Therefore, the safety of its clinical application has aroused wide attention. With the constant deepening of drug development studies, people want to learn about its toxic mechanism and the regularity of its emergence and development of its toxicology, so as to make a scientific and rational assessment for its safety. Therefore, toxicokinetics and metabonomics have gradually become important content in the new drug assessment. During the development of drug performance, it is crucial to establish a scientific, objective and standardized Aconitum safety evaluation system and correctly assess and utilize its toxicity. Having summarized studies on metabonomics and toxicokinetics of Aconitum drugs in recent years, authors proposed to strengthen the studies on Aconitum drug safety assessment and establish a scientific and standardized safety evaluation system as soon as possible, in order to make the national treasure more useful.
Aconitum ; chemistry ; toxicity ; Animals ; Drugs, Chinese Herbal ; pharmacokinetics ; toxicity ; Humans ; Metabolomics

Objective To investigate the influence of folic acid and vitamin B12 levels on the curative effect in Uygur and Han patients with non-small cell lung cancer(NSCLC) treated by first-line chemotherapy of pemetrexed combine with platinum.Methods Sixty-one Uygur and Han cases of NSCLC treated by the first-line chemotherapy of pemetrexed combine with platinum and at least two cycles of this regimen were selected.The folic acid and vitamin B12 levels before chemotherapy were detected by using the electrochemiluminescence method.The chemotherapeutic effect evaluation was performed once at least per 2 weeks.The follow up lasted until the disease progress or first line chemotherapy finish,furthermore the data collected from the two nationalities were performed the comparative analysis.Results The gender,smoking history,age,differentiation degree,staging and vitamin B12 level had no statistical differences between Uygur and Han NSCLC patients(P＞0.05);but the serum folic acid level in Han NSCLC patients was higher than that in Uygur NSCLC patients(P＜0.05).The gender,smoking history,age,tumor differentiation degree,neoplasm staging and serum vitamin B12 level had no influence on the prognosis in NSCLC patients using the pemetrexed combine with platinum chemotherapy(P＞0.05),while the prognosis in Han patients was better than that in Uygur patients(P＜0.05),and the patients with higher folic acid level had good prognosis.The progress free survival(PFS) in Han NSCLC patients was obviously superior to that in Uygur patients.Conclusion The serum folic acid level in Han NSCLC patients is higher than that in Uygur patients,and the curative effect in Han patients receiving the pemetrexed combine with platinum chemotherapy is obviously superior to that in Uygur patients,and serum folic acid level may be related with the prognosis in NSCLC patients.

Taking Doctor HUANG Shi-ping as the representative, the school of Huang's golden needle is based on Chinese martial art. Golden needles are adopted as main tool. Attaching great importance on the combination of acupuncture and moxibustioin, it is also characterized with penetrating needling with long needles. Through the development of three generations, it once outshone other schools in the field of acupuncture, and became famous all over the world. It made great contribution to the development of the course of acupuncture. However, with the development of the history, the form of acupuncture education as well as apparatus were all undergone an unified reform. Therefore, Doctor HUANG Shi-ping's acupuncture school be lost gradually.
Acupuncture ; education ; history ; Acupuncture Therapy ; history ; instrumentation ; methods ; China ; History, 19th Century ; History, 20th Century ; Humans ; Schools

Objective To explore the relationship between ATP content in CD4+ T lymphocytes and acute rejection after liver transplantation(LT). Methods This study contained 77 patients who received LT from February to October 2009, They were divided into AR (acute rejection) and NAR (non-acute rejection) groups while 56 healthy people were enrolled to serve as the control group.Blood specimens were collected preoperatively and at 1, 2 and 4 weeks postoperatively. For the AR group, specimens were also collected on the day when AR occurred and 1 week after steroid bump together with that of the healthy people. ImmuKnowTM test kits for immune cell function were used to assay the ATP value. Results ATP values within CD4+T lymphocytes were elevated significantly in each group compared with those preoperatively. Peak level was reached in the AR group and was significantly higher than that of the contemporary NAR group (P＜0.05). ROC curve analysis showed that the obvious elevation of the ATP value within CD4+ T lymphocytes 1 week postoperatively had better sensitivity and specificity in diagnosing AR. The ATP sensitivity rate for early AR was 84.6 %and specificity rate 81 %. The ATP value within CD4+ T lymphocytes on the day of AR occurrence had a positive relationship with the rejection acting index(RAI), while relative index (r) was 0. 876(P＜0.05). After the steroid dump treatment, AR in all the patients was reversed and the ATP value declined significantly as compared with the control group and the day when AR occurred(P＜0. 05).Conclusion During the postoperative period, the dynamic change of ATP value within CD4 + T lymphocyte had a close relationship with acute rejection after liver transplantation. Thus, it might be used as a feasible and noninvasive monitoring index for diagnosing AR and the effectiveness of the anti-rejection treatment.

Objective To compare the antiarrhythmic effects and safety of landiolol and esmolol .Methods The sequential method was used to detect the median lethal dose ( LD50 ) and 50%effective dose ( ED50 ) of the two drugs.Treatment index were calculated by LD 50/ED50 .Several of arrhythmia models were used to study the antiarrhythmic effects of landio-lol and esmolol in the equivalent dose .Results ED50 and LD50 of landio-lol and esmolol were 14.4 , 17.3 mg? kg -1 and 347 , 100 mg? kg -1 re-spectively , TI were 24.1 and 5.8.The ratio of equivalent dose between landiolol and esmolol on anti -chloroform induced arrhythmia was 0.83∶1.Landiolol and esmolol have similar anti -arrythmia effect on va-rious arrhythmia models.Esmolol has a stronger inhibition function on the heart rate than that of landiolol .Conclusion Compared with esmolol , landiolol has similar antiarrhythmic effect , gentle and slow effect on heart rate, higher treatment index and safety in equivalent dose .

OBJECTIVETo study the correlation of homocysteine (Hcy) in plasma with nitric oxide synthetase (NOS) and endogenous carbon monoxide (CO) in the penile corpus cavernosum of type 2 diabetic rats.

METHODSThis study included 40 male Wistar rats, 10 as controls (Group A) and the other 30 as diabetes mellitus (DM) models. Four weeks after the model establishment, the model rats were divided into a DM group (Group B, n = 10), an insulin treated group (Group C, n = 10), and a folic acid and vitamin B12 treated group (Group D, n = 10). All the rats were injected with apomorphine and observed for penile erection at 8 and 12 weeks, and the levels of total plasma Hcy (tHcy), NOS and CO in the penile corpus cavernosum were measured at 12 weeks.

RESULTSCompared with Group A, the level of tHcy was significantly increased, while NOS and CO activities in the penile cavernous tis-sue and erectile function remarkably decreased in Group B (P < 0.01). The incidence rate of high Hcy was 55% in the DM rats. In comparison, the level of tHcy was obviously decreased, and the NOS activity and erectile function markedly increased in Groups C and D (P < 0.01). The Hcy level showed a significant negative correlation with NOS activity (rA = -0.89, rB = -0.76, rc = -0.91, rD = -0.91) and CO content (TA = -0.82, r, = -0.77, rc = -0.93, rD = -0.81).

CONCLUSIONHigh plasma Hcy can decrease NOS and CO activities in the penile corpus cavernosum, and consequently induce erectile dysfunction in DM rats, while insulin, folic acid and vitamin B12 can improve their penile erectile function by increasing NOS and CO activities.

Animals ; Carbon Monoxide ; metabolism ; Diabetes Mellitus, Experimental ; blood ; physiopathology ; Diabetes Mellitus, Type 2 ; blood ; physiopathology ; Folic Acid ; pharmacology ; Homocysteine ; blood ; Insulin ; pharmacology ; Male ; Nitric Oxide Synthase ; metabolism ; Penis ; drug effects ; metabolism ; Rats ; Rats, Wistar ; Vitamin B 12 ; pharmacology

OBJECTIVETo investigate the clinical features and treatment of multifocal papillary thyroid carcinoma (PTC).

METHODSA retrospective survey was carried out in 648 patients with PTC who underwent surgery from January 1997 to December 2006. One hundred and sixty-eight cases of the patients presented with multiple tumor masses (> or = 2). The risk factors, including sex of the patients, age at diagnosis, family history of thyroid tumor, multiplicity and bilaterality of tumor, extra-thyroidal extension, lymph node involvement and other were analyzed between solitary PTC and multifocal PTC group.

RESULTSThe mean age of the patients was 42 years (range, 14 - 78 years), included 49 male and 119 female. Tumor foci were found in both thyroid lobes in 117 cases (69.6%). Patients with multifocal PTC were characterized by a higher ratio of male (P = 0.004), family history of thyroid tumor (P = 0.031), neck lymph node metastasis (P = 0.008) and extra-thyroidal extension (P = 0.001). However, solitary PTC tended to be with a higher rate of benign goiters in pathologic examination. In multifocal PTC group, male, neck lymphadenectasis, > or = 3 tumor masses or bilaterality of tumor tended to presented with larger tumor, more neck lymph node metastasis and extra-thyroidal extension; And a less malignant tumor in the cases detected with benign goiters in histological examination. By the end of 2007, 164 cases (97.6%) completed follow-up with a mean period of 46.1 months (range, 2 - 127 months), 5 died in the meantime. One patient has been followed-up for 16 months for suspect of lung metastases by chest X-ray. Recurrence occurred in 8 patients and were re-resected, 2 in remnant thyroid and 6 in neck lymph nodes. The overall 1-, 2-, 5-, and 10-year survival rate was 98.2%, 97.4%, 96.5% and 96.5%, respectively. American Joint Committee on Cancer (AJCC) stage was associated with prognosis significantly (chi(2) = 168.832, P = 0.000).

CONCLUSIONSMultifocus is one of the clinical features of PTC and is more malignant than solitary PTC. Total thyroidectomy with central compartment neck dissection could be standard treatment. Lateral nodal dissection is not necessary except for the cases with lymph node metastasis. AJCC stage is still the best prognostic factor.

Adolescent ; Adult ; Aged ; Carcinoma, Papillary ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neck Dissection ; Retrospective Studies ; Survival Analysis ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; Young Adult

BACKGROUNDMicroRNAs (miRNAs) are small noncoding regulatory RNAs whose aberrant expression may be observed in many malignancies. However, few data are yet available on human primary medulloblastomas. This work aimed to identify that whether miRNAs would be aberrantly expressed in tumor tissues compared with non-tumorous cerebellum tissues from same patients, and to explore a possible role during carcinogenesis.

METHODSA high throughput microRNA microarray was performed in human primary medulloblastoma specimens to investigate differentially expressed miRNAs, and some miRNAs were validated using real-time quantitative RT-PCR method. In addition, the predicted target genes for the most significantly down- or up-regulated miRNAs were analyzed by using a newly modified ensemble algorithm.

RESULTSNine miRNA species were differentially expressed in medulloblastoma specimens versus normal non-tumorous cerebellum tissues. Of these, 4 were over expressed and 5 were under expressed. The changes ranged from 0.02-fold to 6.61-fold. These findings were confirmed using real-time quantitative RT-PCR for most significant deregulated miRNAs (miR-17, miR-100, miR-106b, and miR-218) which are novel and have not been previously published. Interestingly, most of the predicted target genes for these miRNAs were involved in medulloblastoma carcinogenesis.

CONCLUSIONSMiRNAs are differentially expressed between human medulloblastoma and non-tumorous cerebellum tissue. MiRNAs may play a role in the tumorigenesis of medulloblastoma and maybe serve as potential targets for novel therapeutic strategies in future.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Medulloblastoma ; genetics ; MicroRNAs ; genetics ; metabolism ; Oligonucleotide Array Sequence Analysis ; Reverse Transcriptase Polymerase Chain Reaction

[Abstact] Objective To investigate the characteristics of heart rate variability (HRV) of ambulatory electrocardiogram in patients with acute stroke, and evaluate the predictive value of HRV in stroke prognosis. Methods Eighty-three patients acute stroke (study group) and 83 cases of healthy subjects (control group) from October 2016 to October 2017 in Dalian Municipal Central Hospital Affiliated of Dalian Medical University were selected. The 24 h ambulatory electrocardiogram was performed to determine HRV in 2 groups, including standard deviation of NN intervals (SDNN), standard deviation of the 5 min mean cycle lengths (SDANN), root-mean-square successive difference (RMSSD) and percentage value of NN50 count (PNN50). Results The SDNN, SDANN, RMSSD and PNN50 in study group were significantly lower than those in control group: (80.83 ± 10.52) ms vs. (148.11 ± 22.59) ms, (79.98 ± 8.89) ms vs. (129.35 ± 5.34) ms, (19.28 ± 4.25) ms vs. (39.57 ± 2.38) ms and (5.91 ± 2.12) % vs. (19.35 ± 12.15) %, and there were statistical differences (P＜0.05). Among the 83 patients with acute stroke, there were no statistical differences in SDNN, SDANN, RMSSD and PNN50 between ischemic stroke (54 cases) and hemorrhagic stroke (29 cases) (P＞0.05). The SDNN, SDANN, RMSSD and PNN50 in right stroke (43 cases) were significantly lower than those in left stroke (40 cases): (75.18 ± 2.32) ms vs. (88.12 ± 3.58) ms, (73.36 ± 2.18) ms vs. (85.69 ± 7.29) ms, (17.57 ± 1.67) ms vs. (20.58 ± 4.23) ms and (4.39 ± 1.57) % vs. (8.61 ± 1.12) %, and there were statistical differences (P＜0.05). Patients were followed up for 1 year, 24 died and 59 survived. The SDNN, SDANN, RMSSD and PNN50 in dead patients were significantly lower than those in survived patients: (92.35 ± 4.58) ms vs. (154.37 ± 4.65) ms, (76.23 ± 4.03) ms vs. (143.95 ± 4.34) ms, (7.43 ± 2.12) ms vs. (31.65 ± 1.52) ms and (2.35 ± 0.46) % vs. (11.65 ± 0.48) % , and there were statistical differences (P＜0.05). Conclusions The autonomic nervous function of patients with acute stroke is seriously unbalanced, with increased sympathetic excitability and decreased vagus excitability. The decrease of HRV can easily induce cardiac events and seriously affect the prognosis.