Objective To compare the applicability of the 7th and 6th editions of the UICC-AJCC esophageal cancer TNM staging systems for adenocarcinoma of esophagogastric junction (EGJ).Methods During June 2007 through December 2010,199 patients with EGJ adenocarcinoma(Siewert type Ⅱ) underwent R0-intent resection in our hospital.Their clinicopatholigical and survival data were retrospectively analyzed with Kaplan-Meier and Cox regression models.They were restaged according to the 7th and 6th UICC/AJCC TNM staging systems for esophageal cancer,respectively.Then the Akaike information criterion(AIC) was used for measuring goodness of fit of both staging systems.Results Among 199 patients,there were 162 males and 37 females.Univariate analysis indicated that age(P =0.009),surgical approach(P =0.002),cell differentiation (P =0.030),preoperative co-morbidity (P =0.026),depth of tumor invasion (P ＜ 0.000) and number of metastatic lymph nodes(P ＜ 0.000) were significant influencing factors on overall survival.Multivariate analysis demonstrated that the independent prognostic factors for EGJ adenocarcinoma were age,T stage,N stage and preoperative co-morbidity according to the 6th edition of esophageal cancer TNM staging system,and only T stage,N stage and preoperative co-morbidity according to the 7th edition of esophageal cancer TNM staging system.The AIC value was 961.4 for the 7th edition of esophageal cancer staging system and 972.4 for the 6th edition.Conclusion The 7th edition of UICC/AJCC esophageal cancer TNM classification is su perior to its 6th edition of esophageal cancer staging system for EGJ adenocarcinoma.

Objective To investigate the clinical efficacy and safety of dexmedetomidine combined with sevoflurane in elderly patient undergoing percutaneous nephrolithotomy.Methods Forty ASA Ⅰ ～ Ⅱ elderly patients of both sexes,aged 65 ～ 76 (71.0 ± 6.0)yr,scheduled for elective surgery of percutaneous nephrolithotomy under general anesthesia,were randomly divided into two groups (n =20 each):dexmedetomidine/sevoflurane group (group D) and propofol/sevoflurane group (group P).All patients received fentanyl,propofol,and cisatracurium for anesthesia induction.After endotracheal intubation,patients in group D received an initial loading dose of 0.5 μg/kg (4 μg/ml) of dexmedetomidine over 10 min,followed by a continuous infusion of 0.3 ～ 0.6 μg/(kg · h).Patients in group P received an initial loading dose of 1 mg/kg of propofol over 10 min,followed by a continuous infusion of 3 ～ 6 mg/(kg · h).All patients received the inhalation of sevoflurane for maintenance.Bispectral index was used to maintain a similar level of hypnosis in both groups (40 ～ 60).The heart rate (HR),blood pressure (BP) [systolic blood pressure (SBP)/diastolic blood pressure (DBP)],oxygen saturation (SpO2),end-tidal carbon dioxide partial pressure (PETCO2) at different time points before anesthesia (T0),10 min after prone position (T1),30 and 60 min started lithotripsy (T2-3),and at the end of operation (T4) were recorded,respectively.The operation time,amount of blood loss,and volume of fluid infusion were recorded.Recovery time of spontaneous ventilation,awaking time (open eyes by calling),extubation time,staying time at postanesthesia care unit (PACU),and relevant complications were also recorded.Results Compared to the baseline value at T0,SBP and DBP were significantly decreased at T1 in both groups(P ＜0.05),and no significant differences in the SBP,DBP,SpO2,and PETCO2 were found between two groups(P ＞ 0.05).Compared to the baseline value at T0,the HR was significantly decreased at T1 ～ T4 in group D (P ＜ 0.05),the HR was significantly lower at T1 ～ T4 in group D than that of group P (P ＜ 0.05).No significant differences in operation time,amount of blood loss,and volume of fluid infusion were found between two groups (P ＞ 0.05).No significant differences in recovery time of spontaneous ventilation,staying time at PACU,nausea,vomit,and agitation were found between two groups (P ＞ 0.05),while awaking time and extubation time were significantly longer in group D than that of group P(P ＜ 0.05).The shivering was significantly less in group D than that of group P (P ＜ 0.05).Conclusions Both dexmedetomidine/sevoflurane and propofol/sevoflurane anesthesia are suitable for elderly patients undergoing percutaneous nephrolithotomy.Dexmedetomidine/sevoflurane makes time of awake and extubation longer,but dexmedetomidine can reduce the shivering and the attendant complications caused by shivering.

Objective To reverse P-glycoprotein-mediated muhiple drug resistance using RNA interference(RNAi)in cultured rat astrocytes.Methods Astroeytes overexpressing P-glyeoprotein induced by coriaria lactone were transfected with the short-hairpin RNA expression vector-p-SIREN shuttle designed to target Mdrl mRNA.The mRNA level of Mdrl gene was evaluated by real-time PCR;the P-glycoprotein was examined by immunocytochemistry and image analysis,meanwhile the rhodamine efflux was assessed by flow cytometry.Results The astrocyte model overexpressing P-glycoprotein were established and successfully transfected with the short-hairpin RNA expression vector-p-SIREN shuttle.The mRNA level of Mdrl gene was knocked down by 67.70%(P

The purpose of this study is to find out anti-HIV-1 reverse transcriptase (RT)/protease (PR) activity and inhibition of virus replication in cell cultures of novel coumarin analogs and determine their structure-activity relationship. Coumarin derivatives have been demonstrated to inhibit the activity of HIV-1 RT/PR in cell free system. It also shows inhibition effects to HIV-1 replication in cell culture. Based on the Chinese traditional pharmacological characteristics and protein three dimension computer aided design, analogs of tetracyclic dipyranocoumarin were synthesized from natural leading compounds. We studied the relationship of antiviral effects and chemical structures via HIV-1 PR/RT enzyme models and cell culture model system. Seven compounds were designed and tested. Several compounds showed anti-HIV-1 activity in varying degrees, especially V0201 showed much higher anti-HIV-1 activity with 3.56 and 0.78 micromol x L(-1) of IC50 against HIV-1 PR/RT and 0.036 micromol x L(-1) against HIV-1 replication in PBMC cultures. V0201 with a novel structure may be a new leading compound. These new compounds are valuable for development of new anti-HIV drugs in the future.

Objective To investigate the differences on lymphatic vessel density (LVD) among esophageal adenocarcinoma (EAC),esophageal squamous cell carcinoma (ESCC) and normal esophageal tissues,and analyze the clinical significance.Methods Twenty samples of EAC,24 samples of ESCC and 20 cases of normal esophageal tissues were obtained at the Affiliated Hospital of North Sichuan Medical College from January 2004 to January 2011.D2-40 was used for immunostaining of lymphatic vessels in EAC,and antibodies of D2-40 and Ki-67 were used together to detect proliferation of lymphatic vessels.The differences in the LVD among EAC,ESCC and normal esophageal tissues were analyzed.All data were analyzed using the analysis of variance or t test.Results D2-40 staining could identify the lymphatic vessels,and antibodies of D2-40 and Ki-67 could detect the proliferation of lymphatic vessels.The LVD of EAC,ESCC and normal esophageal tissues were (3.3 ± 1.7)/0.17 mm2,(4.6 ± 1.2)/0.17 mm2 and (3.8 ± 1.2)/0.17 mm2,respectively,with significant differences (F =5.44,P ＜0.05).The LVD of EAC was significantly lower than that of ESCC (t =3.074,P ＜ 0.05),while there was no significant difference in the LVD between the EAC and normal esophageal tissues (t =-1.022,P ＞ 0.05).There were significant differences in the LVD between the ESCC and normal esophageal tissues (t =2.395,P ＜ 0.05).There were significant differences in the LVD between EAC patients with deglutition discomfort and those with pain (t =3.092,P ＜ 0.05).There were significant differences in the LVD between EAC patients with course ＜6 months and those with course≥6 months (t =3.092,P ＜ 0.05).No statistical difference in clinicopathological parameters including gender,age,site of lesion,tumor diameter,pathological morphology,T stage,N stage,G stage,TNM clinical stage and lymph node metastasis were detected (t ＝ 1.130,1.020,F =0.082,t =0.799,F =0.692,t =0.694,1.820,0.353,0.969,0.969,P ＞ 0.05).Conclusions The LVD of EAC is lower than that of ESCC,but is similar to that of normal esophageal tissues.The LVD of EAC is correlated with the symptoms and course of patients.

With the recognition of antineutrophil cytoplasmic antibodies (ANCA)-related vasculitis and widespread vaccination against viral hepatitis B, the prevalence of polyarteritis nodosa (PAN) varied considerably. In our study, patients diagnosed as polyarteritis nodasa (PAN)based on the 1990 American College of Rheumatology(ACR) criteria were reclassified using 2007 European Medicines Agency(EMA) algorithm modified by 2012 Chapel Hill Consensus Conference(CHCC) definitions, aiming to evaluate the new classification criteria for the diagnosis of PAN. A total of 113 PAN patients admitted to Peking Union Medical College Hospital from January 2002 to December 2018 were retrospectively analyzed, who were classified into three subtypes including 9 patients with cutaneous, 80 with classic and 24 Hepatitis B virus (HBV) associated PAN. All patients were reclassified according to 2007 EMA algorithm using CHCC 2012 definitions. As a result, 7 patients were diagnosed as microscopic polyangiitis(MPA) and 19 patients with unclassified vasculitis based on the new classification criteria. The diagnostic rate of PAN was gradually declined as the classification criteria of vasculitides was update. However, there are quite a few PAN patients in China, whom rheumatologists should pay attention to the early diagnosis and treatment.

Objective To study postoperative delirium in elderly patients.Methods We investigate the morbidity of postoperative delirium in 142 elderly patients (≥ 60 years)after gastrointestinal surgery by using Confusion Assessment Method (CAM) and Delirium Rating Scale Revised-98 (DRS-R98) scores.Data were analyzed using Student's t test and Chi-squaretest respectively with SPSS 19.0.Results Of 142 patients,delirium was diagnosed in 36 patients(25.4％),delirium developed in 4,7,17,7,1 patients in posto perative 1,2,3,4-7,7 + days respectively.There were significant difference in hospital stay:17.7 ± 2.6 days (postoperative delirium) and 13.4 ± 2.3 days (no postoperative delirium),t =4.608,P =0.000 1.The postoperative complications (52.8％ / 23.6％,x2 =10.710,P =0.001) and ICU admission (22.2％/6.6％,x2 =6.939,P =0.008) significantly increased.Conclusions Postoperative delirium is recognized as one of the most common surgical complications in elderly patients with gastrointestinal surgery leading to other major postoperative complications,and prolonged hospitalization.

Objective To evaluate the clinical effects of amino acid-based formulae (AAF) combined with rice oil in treating children with persistent diarrhea caused by cow's milk protein allergy (CMPA).Methods We selected 60 infants (6-12 months) with CMPA-induced persistent diarrhea treated in Tianjin Children's Hospital between April 2011 and December 2013 and divided them into control group (n =30) and observation group (n =30) with a random number table.The control group was given AAF treatment,while the observation group was given the combination treatment of AAF + rice oil The two groups were compared in terms of treatment efficiency,period before improvement of stools,antidiarrheal time,early adverse reactions (vomit,abdominal distension),and the period before disappearance of systemic symptoms (frequent crying).Results The effective rate was 89.3％ in the control group and 96.7％ in the observation group,with no statistically significant difference (P =0.267).Adverse reactions disappeared significantly earlier in the observation group than in the control group [abdominal distension:(7.2 ± 1.7) days vs.(9.4 ±2.3) days; vomit:(8.6 ±2.5) days vs.(12.5 ±2.0) days; frequent crying:(8.0 ± 1.6) days vs.(10.0 ± 2.1) days; all P =0.000].Conclusions AAF is the first choice to treat CMPA-induced diarrhea.Early use of AAF in combination with rice oil could achieve better feeding tolerance in infant with CMPA-induced diarrhea.

Objective To study the effect of rice oil on secretory immunoglobulin A (sIgA) content in feces and disease outcome in children with acute diarrhea.Methods We selected 180 children with acute diarrhea hospitalized in Tianjin Children's Hospital during the period from January 2013 to October 2014.They were randomly divided with a random number table into rice oil group,montmorillonite powder group and control group (all n =60).The effect of treatment,duration before subsiding of diarrhea and vomit,length of hospital stay and sIgA content in feces before and after treatment were analyzed.Results The total effective rates in the rice oil group and the montmorillonite powder group (93.3％,96.7％) were significantly higher than that in the control group (76.7％,P =0.011,P =0.001).Length of hospital stay,duration before subsiding of diarrhea and vomit in the rice oil group and the montmorillonite powder group were significantly shorter than those in the control group[(5.6±1.4) d,(5.7±1.6) d vs.(6.9±1.8) d;(3.7±0.9) d,(3.5±0.9) d vs.(5.4±1.2) d;(2.8 ± 0.6) d,(3.2 ± 0.8) d vs.(5.1 ± 0.8) d;all P =0.000].The total effective rates,length of hospital stay,duration before subsiding of diarrhea showed no statistically significant differences between the rice oil group and the montmorillonite powder group (P =0.402,0.716,0.226),but the duration before subsiding of vomit in the rice oil group was significantly shorter than that in the montmorillonite powder group (P =0.016).Before treatment,the sIgA contents in feces in the control group,the montmorillonite powder group,the rice oil group were 0.527 ± 0.133,0.487 ± 0.109,0.534 ± 0.150,with no significant difference (P ＞ 0.05).Two days after treatment,sIgA contents in the rice oil group and the montmorillonite powder group (0.669 ±0.176,0.612 ± 0.161) were significantly higher than in the control group (0.541 ±0.149,P =0.000,0.014).There was no significant difference between the montmorillonite powder group and the rice oil group (P =0.067).Four days after treatment,sIgA content in the montmorillonite powder group (1.981 ±0.462) was significantly higher than in the control group (1.762 ±0.378,P =0.005),while sIgA content in the rice oil group (2.331 ± 0.494) was significantly higher than in the other 2 groups (P =0.000).Compared with the levels before treatment,sIgA content 2 days after treatment was not significantly changed in the control group (P =0.295),but was significantly elevated in the montmorillonite powder group and the rice oil group (both P =0.000).sIgA contents of all the three groups 4 days after treatment were significantly higher than the contents 2 days after treatment (all P =0.000).Conclusion The effect of rice oil on acute diarrhea in children is as same as that of montmorillonite powder,and may be better in mitigating vomit and promoting the secretion of intestinal sIgA.

Objective To evaluate the effectiveness offour in onenutrition management mode in the treatment of type 1 diabetes mellitus (T1DM) in children. Methods Ninety children diagnosed with T1DM in Tianjin Children's Hospital were selected during March 2011 to June 2013. Segmented balanced random method was used to generate a random number timer, and the children were divided into intervention group and control group (n=45) by random letters. The patients in the intervention group were treated withFour in one nutrition management. Those in the control group were treated with traditional nutrition education method. Observation period was one year. The change of food choices of the parents was assessed before and after the intervention. Nutritional treatment compliance of children,fasting plasma glucose (FPG),2 hours postpransial glucose (2 hPG),and hemoglobin A1c (HbA1c) levels and complications, and so on were also evaluated. Results One year after intervention, the percentages of parents who chose low glycemic index food (41/45), vegetables and fruits consumed every day (40/45), often ate soy products(41/45), did not drunk carbonated drinks (43/45) of treatment group were significantly higher than those of control group (24/45, 20/45, 19/45, 26/45, P all<0.001);diet treatment compliance of children in treatment group was significantly better than that of the control group (P=0.000 2);FPG, 2 hPG, HbA1c of two groups of children decreased significantly than before. FPG[(8.11 ± 2.82) mmol/L], 2 hPG [(12.82 ± 1.05) mmol/L], HbA1c [(6.10±0.93)%] of treatment group were significantly lower than those of the control group [(11.71± 2.75) mmol/L, (13.77±1.49) mmol/L, (9.02±0.93)%;t=6.13, 1.66, 14.89;P<0.001 for all comparisons]. After treatment, 14 cases of treatment group had acute ketoacidosis and hypoglycemia , while 39 cases of control group had these complications (P=0.000 00). Readmission occurred in 11 cases of treatment group and 33 of the control group (P=0.000 00). Conclusions Four in onenutrition management mode was effective in the management of children with T1DM.