Objective To evaluate the efficacy and safety of azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC).Methods Retrospective analysis of the clinical improvement,endoscopic improvement and mucosal healing rate,inflammation marker improvement after AZA administration and its safety in 24 refractory UC patients were performed,who were recruited between January 2007 and December 2011 in West China Hospital,Sichuan University,China.Results Twenty-four patients were enrolled,with a median age of 36 years old and a median course of 4 years.Among them,14 cases were moderate UC and 10 cases were severe UC.The patients were treated with AZA in a dose of (1.23 ±0.34) mg· kg-1 · d-1 from 7 weeks to 42 months.Efficacy was judged by Mayo disease activity index.At 3 months,6 months and 1 year after treatment,the effective rates were 73.9％ ( 17/23),81.8％(18/22) and 14/16 respectively,and the remission rates were 17.4％ (4/23),54.5％ (12/22) and 12/16respectively.Both ESR and C reactive protein level after treatment for 6 months and 1 year were significantly lower than those before treatment [ (9.3 ±8.9) mrn/1h,(10.9 ±7.3) mm/1h vs (22.3 ± 10.7) mm/1h;2.5(1.0-22.3) mg/L,2.3(1.0-28.0) mg/L vs 18.4(3.6-137.0) mg/L; all P ＜0.05].Corticosteroid withdrawal rates at 3 months and 1 year after AZA treatment were 16/18 and 15/16,respectively.At 6 months and 1 year after AZA treatment,the endoscopic improvement rates were 85.7％ ( 18/21 ) and 13/15 respectively; the cndoscopic remission rates were 61.9％ ( 13/21 ) and 11/15 respectively; and the mucosal healing rates were 61.9％ ( 13/21 ) and 11/15 respectively.Adverse effects were occurred in 8 patients.Leukopenia was the most common adverse effect,followed by liver function injury,alopecia and epigastric discomfort.Conclusions AZA is effective in the treatment of refractory UC patients with a low dose of ( 1.23 ± 0.34) mg· kg - 1 · d - 1,especially in the steroid withdrawing,maintaining remission and mucosal healing without severe adverse effects.

Objective To investigate the effect of pretreatment with dexmedetomidine alone or in combination with sufentanil on myocardial ischemia-reperfusion (I/R) injury in rats.Methods Fifty healthy male Sprague-Dawley rats,weighing 250-300 g,were anesthetized with intraperitoneal pentobarbital sodium 60 mg/kg.Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 120 min of reperfusion.The rats were then randomly divided into 5 groups (n =10 each):sham operation group (group S),group I/R,dexmedetomidine pretreatment group (group DP),sufentanil pretreatment group (group SP),and dexmedetomidine + sufentanil pretreatment group (group DS).In group S the anterior descending branch was only exposed but not ligated.Dexmedetomidine 0.5μg/kg and sufentanil 0.1μg/kg were injected intraperitoneally 30 min before ischemia in groups DP and SP,respectively.Dexmedetomidine 0.5 μg/kg and sufentanil 0.1 μg/kg were injected intraperitoneally 30 min bbefore ischemia in group DS.Arterial blood samples were collected at 120 min of reperfusion for determination of serum creatine kinase (CK) and lactic dehydrogenase (LDH)concentrations.The rats were sacrificed at 120 min of reperfusion and hearts were removed for microscopic examination.Myocardial infarct size was calculated.The malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in myocardial tissues were measured.Results Compared with group S,the serum CK and LDH concentrations were significantly increased,the myocardial infarct size was enlarged,and SOD activity was decreased in the other groups,MDA content was significantly increased in groups I/R,DP and SP (P ＜ 0.05 or 0.01).Compared with group I/R,the serum CK and LDH concentrations,MDA content and myocardial infarct size were significantly decreased,and SOD activity was increased in groups DP,SP and DS (P ＜ 0.05).Compared with group DS,the serum CK concentration was significantly increased,the myocardial infarct size was enlarged,and MDA content was increased in groups DP and SP,and LDH concentration was significantly increased and SOD activity was decreased in group DP (P ＜ 0.05).The pathological changes were significantly attenuated in groups DP and SP compared with group DS.Conclusion Dexmedetomidine pretreatment can reduce myocardial I/ R injury in rats,dexmedetomidine combined with sufentanil pretreatment provides better efficacy than either alone,and inhibition of lipid peroxidation is involved in the mechanism.

To determine the effect of pre-operative chemotherapy on apoptosis in breast cancer and to evaluate its signif icance as a prcgnostic marker. MethodsPatients with breast cancer were divided into preoperative chemotherapy group (40 cases)and control group (42 cases). Two groups were analyzed for the appearance of apoptosis by using TUNEL method and electron mi croscope in tissue sections. ResultsApoptosis occurred in 92.5 % of preoperative chemotherapy group and in 78.5 % of control group. The apoptotic indexes were 19.37 + 6.49 and 9.26 + 5.04 ( P ＜ 0.01 ) respectively. Low apoptotic index was related to disease-free survival of patients with breast cancer (P ＜ 0.01 ). ConclusionThe preoperative chemotherapy can induce apoptcsis of breast cancer and improve disease-free survival.

Objective To evaluate the effect of ulinastatin on oxidative stress injury to myocardial cells in diabetic rats in vitro.Methods The H9c2 cells were cultured in DMEM culture medium and the cells at the logarithmic growth phase were seeded in 96-well plates (density 1 × 104 cells/ml,200 μl/well) or in 6-well plates (density 1× 105 cells/m1,2 ml/well).The cells were randomly divided into 4 groups (n=18 each) using a random number table:normal control group (group C),high-glucose group (group HG),high-glucose + oxidative stress group (group HG+OS),ulinastatin +high-glucose+oxidative stress group (group U+HG+OS).The cells were cultured in high-glucose DMEM culture medium (25.0 mmol/L) for 48 h in group HG.After the cells were cultured in high-glucose DMEM culture medium for 24 h,H2O2 with the final concentration of 500 μmol/L was added to the high-glucose culture medium,and the cells were continuously cultured for 24 h in HG+OS and U+HG+OS groups.In group U+HG+OS,ulinastatin 400 U/ml was added to the high-glucose culture medium.The cells were collected for determination of cell viability,H9c2 apoptosis,activity of superoxide dismutase (SOD) and contents of malonadehyde (MDA).Apoptosis rate was calculated.The cell culture supernatant was collected for detection of lactate dehydrogenase (LDH) activity.Results Compared with group C,the cell viability and SOD activity were significantly decreased,and the apoptosis rate,MDA content and LDH activity were increased in the other groups.Compared with HG group,the cell viability and SOD activity were significantly decreased,and the apoptosis rate,MDA content and LDH activity were increased in HG+OS and U+HG+OS groups.Compared with group HG+OS,the cell viability and SOD activity were significantly increased,and the apoptosis rate,MDA content and LDH activity were decreased in group U + HG+ OS.Conclusion Ulinastatin can mitigate oxidative stress injury to myocardial cells in diabetic rats,and inhibited cell apoptosis is involved in the mechanism.

Objective To evaluate the application of echocardiography in guiding percutaneous balloon pulmonary valvuloplasty in children and to summarize the key echocardiographic planes used in the procedure Methods From February 2013 to September 201 5 38 isolated congenital pulmonary valve stenosis patients were recruited Case inclusion criteria age ≥3 years old purely congenital pulmonary valve stenosis and pulmonary transvalvular pressure gradient ≥40 mmHg Echocardiography was used to assess the severity of pulmonary valve disease and to measure pulmonary transvalvular pressure gradient before procedure Intraoperative transthoracic or transesophageal echocardiography was used to monitor the whole process of percutaneous balloon pulmonary valvuloplasty and to evaluate immediate postoperative efficacy of the procedure All patients were followed up by echocardiography after a month post-discharge Results Thrity eight cases were successfully treated by echocardiography-guided percutaneous balloon pulmonary valvuloplasty The average age of children was 7 1 ±2 5 years mean body weight was 25 3 ±7 1 kg Before the procedure pulmonary transvalvular pressure gradient was 65 9 ± 8 9 mmHg pulmonary annular diameter was 14 6±1 1 mm Immediate postoperative pulmonary transvalvular pressure gradient was 1 5 5 ± 3 4 mmHg All children survived and had no significant complications After a month pulmonary transvalvular pressure was 16 1 ± 3 3 mmHg Conclusions Echocardiography plays an important role in percutaneous balloon pulmonary valvuloplasty for children with congenital pulmonary valve stenosis As a non-x ray guided way it has advantages in preoperative screening of patients intraoperative real-time monitoring and postoperative assessment of efficacy The key sections of echocardiography for intraoperative monitoring are four-chamber and aortic short axis view.

OBJECTIVETo review the clinical characteristics and treatment outcomes of primary intestinal non-Hodgkin's lymphomas (PINHL) and analyze the differences between T-cell and B-cell lymphomas.

METHODSThe characteristics of PINHL patients treated in our hospital between January 2003 and December 2010 were reviewed for their clinical manifestations, diagnosis, endoscopic findings, treatments and outcomes.

RESULTSEighty-five cases of PINHL meeting the Dawson's criteria were identified. The median age of the patients at the time of diagnosis was 52 years and the male: female ratio was 3.05:1; 58 cases (68.2%) had B-lineage and 27 cases (31.8%) had T-cell lineage lymphomas. Compared to those with B-cell lymphoma, patients with T-cell lymphomas showed a younger age of disease onset (32 vs 56 years, P<0.01) and presented with a greater incidence of such symptoms as fever, hematochezia, diarrhea and night sweats (P<0.05); T-cell lymphoma showed more multifocal and ulcerative/ulcero-infiltrative lesions under endoscope with a longer diagnosis time (4 vs 2 months, P<0.01) and a greater likeliness of misdiagnosis (16/27 vs 12/58, P<0.01) and poor prognosis. Extranodal NK/T-cell lymphoma was the most common type of T-cell lymphomas.

CONCLUSIONIn our cases, T-cell lymphoma appeared to be more common than B-cell lymphoma with a younger onset age, more difficult diagnosis, a greater likeliness of misdiagnosis, poorer prognosis and more extranodal NK/T-cell lymphoma.

Adolescent ; Adult ; Aged ; Female ; Humans ; Intestinal Neoplasms ; Lymphoma, B-Cell ; pathology ; Lymphoma, Non-Hodgkin ; pathology ; Lymphoma, T-Cell ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult

Objective To investigate the efficacy and safety of percutaneous induced thrombosis closure on small patent ductus arteriosus (PDA) solely under echocardiography guidance.Methods From June 2013 to September 2016,276 PDA patients were treated by femoral artery retrograde approach under echocardiography guidance.Twenty-five patients (14 boys,11 girls) among them with small PDA received percutaneous induced thrombosis closure because the delivery sheath could not pass PDA,with mean age (3.7 ± 1.6) years,mean body weight (16.6 ±5.4) kg and the mean diameter of the most narrow PDA was (1.3 ± 0.4) mm.All patients were assessed by transthoracic echocardiography,chest radiography and electrocardiography preoperatively.The intraoperative and postoperative effects were evaluated by echocardiography.Outpatient assessment was performed at 1,3,6 and 12 months after operation with electrocardiography and echocardiography,and yearly thereafter.Results Twenty-five patients were successfully treated with percutaneous induced thrombosis closure solely under echocardiography guidance.The mean operation time was (35.2 ± 6.1) minutes.The immediate residual shunt rates and 24 hours after operation were 28.0％ (7/25 cases) and 16.0％ (4/25 cases),respectively.All patients recovered and were discharged from hospital.The average hospitalization stay was (3.0 ± 0.6) days.The mean follow-up was (16.8 ± 12.3) months,residual shunt was observed in 2 patients (8.0％),and it decreased from 1.5 mm and 2.0 mm preoperatively to 0.8 mm and 1.0 mm postoperatively,respectively.All patients survived without peripheral vascular injury,cardiac perforation,PDA rupture or thrombembolia.Conclusions Percutaneous induced thrombosis closure of small PDA solely under echocardiography guidance is safe and effective.It can avoid occluder implantation and radiation injury.However,the residual shunt after operation needs following up closely.

Objective: In order to avoid the radiation and contrast agent injury, and to extend the echocardiography guided percutaneous ventricular septal defects (VSD) closure, based on femoral artery approach, we assessed the efifcacy and safety of VSD closure via trans-jugular approach solely under the guidance of echocardiography.
Methods: A total of 12 patients with peri-membranous VSD treated in our hospital from 2014-10 to 2015-04 were enrolled. The patients were at the age at (1.2-3.5 with the mean of 2.4 ± 0.8 ) years, the body weight at (7-15 with the mean of 11.6 ± 2.6) kg and the diameter of VSD was (3.5-6 with the mean of 4.8 ± 0.7) mm. The patients received percutaneous VSD closure via transjugular approach solely under the guidance of echocardiography. The procedural effect was evaluated by echocardiography and the follow-up study was conducted at 1, 3 and 6 month safter the procedures.
Results: There were 9 patients successfully ifnished VSD closure via trans-jugular approach. 1 patient was converted to femoral artery approach because the wire could not pass through the defect of ventricular septal; 1 was converted to minimally invasive per-ventricular closure since the catheter could not pass through the defect; 1 was converted to conventional surgical repair due to the residual shunt was more than 2mm. The procedural time was (53-89 with the mean of 67.2±12.5) min, the diameter of symmetrical occluder was (6-8 with the mean of 7.0±0.9) mm. 2 patients had immediate post-operative residual shunt, all patients were recovered and discharged. No peripheral vascular injury and cardiac perforation occurred, the hospitalization time was (3-5 with the mean of 3.6 ± 0.7) days. The follow-up examination was conducted at (1-6 with the mean of 3.9 ± 2.1) months, the slight residual shunt in 2 patients disappeared at 1 month after procedure; no pericardial effusion, occluder malposition, aortic regurgitation and atria-ventricular block occurred.
Conclusion: Echocardiography guided trans-jugular approach of VSD closure is safe and effective, it may particularly avoid the radiation and contrast agent injury in clinical practice.

Objective To investigate the potential pathogenesis of Focal cortical dysplasia (FCD), we performed cDNA microarray analysis to obtain gene expression profile of FCD. Methods Three FCD samples and three normal controls were enrolled. Total RNA of the brain tissues were extracted. The difference gene expressions between FCD group and control group was detected using Affymetrix gene chip. The up and down-regulated genes were confirmed by Real-time PCR. Further, the related signal pathways involved in the pathogenic mechanisms of FCD were predicted by bioinformatics. Result In FCD, two up-regulated genes C21orF2 and AU152162 and 5 down-regulated genes ENPP2, ANLN, IP6K3, UGT8, and AZGP were found. Compared the FCD samples with the normal controls , there were significantly different in all down-regulated genes (P < 0.05), while the up-regulated genes were not (P > 0.05). Using bioinformatics analysis, the ENPP2 , UGT8 , and AZGP1 protein which located in the cell membrane or secreted into the extracellular matrix may be involved in the formation of the myelin sheath and the development of the nervous system by the lipid metabolism and LPA signaling pathway. Conclusion ENPP2, UGT8 and AZGP1 may be involved in pathogenesis of FCD through the process of myelin sheath formation and LPA signal pathway , which warrants further study to know their roles in the pathogenesis of FCD.

Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography.
Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure.
Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation.
Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.