Objective To investigate the effect of multidisciplinary diagnosis and treatment including ex-utero intrapartum treatment (EXIT) procedure to improve the prenatal survival rate of fetus with neck mass.Methods Multidisciplinary diagnosis and treatment model were carried out in four pregnancy women with fetal neck mass from September 2007 to February 2010.The model included prenatal assessment and monitoring,EXIT procedure during cesarean section,neonatal reassessment and surgical treatment by the cooperation of obstetricians,neonatologists,children surgeons,sonographers and anesthetists.Results All patients underwent cesarean section after 37gestational weeks.Mean delivery time was 37+4 weeks (37-38+3 weeks); mean birth weight was 2972 g (2600-3250 g); mean operation time was 4 min (2-7 min).The gestational age of primary diagnosis of fetal neck mass was 24-34 gestational weeks.After delivery,the size of neck mass was from 3.0 cm × 2.0 cm × 1.0 cm to 6.2 cm× 5.8 cm × 6.8 cm.The tracheal compression and displacement were found by color doppler ultrasound scan and magnetic resonance imaging in all cases.Two of them were completed with polyhydramnios and the others with normal volume of amniotic fluid.EXIT procedure was successfully carried out during cesarean section.Neonatal reassessment showed the trachea of three infants were obviously compressed and lapsed by enhanced CT; the infants relied on mechanical ventilation after birth and underwent operation on day 6 to 8.Tracheal impression was not presented in one infant and trachea cannula was removed on the second day,operation was not performed.All of those infants had good outcomes.Conclusions The multidisciplinary diagnosis and treatment model,including EXIT procedure,is a safe,efficient and feasible strategy,which is necessary for fetus with neck mass.

Objective To analyze IGFBP1 expression in gastric cancer,prognosis and involved biological functions through comprehensive approach,and to explore its diagnostic and therapeutic value in gastric cancer.Methods The expression level of IGFBP1 in gastric cancer was obtained using TCGA data,and the differences of expression in different clinicopathological stages and survival states were analyzed.Kaplan-Meier curve was used to describe the relationship between IGFBP1 expression and prognosis of gastric cancer patients.The diagnostic and prognostic value of IGFBP1 in gastric cancer was evaluated using ROC curve,Cox regression and Meta-analysis.A prognostic model associated with IGFBP1 was established after LASSO regression analysis,and the IGFBP1-related core genes were identified in PPI network.GO,KEGG and CIBERSORT were used to analyze the potential pathogenic pathways and immune cell infiltration associated with IGFBP1 in gastric cancer.The correlation between IGFBP1 and anti-tumor drug sensitivity was predicted based on Cell Miner database.Results IGFBP1 was abnormally expressed in a variety of cancers,including gastric cancer,and its expression was significantly up-regulated in patients with stage Ⅲ-Ⅳ gastric cancer.Cox regression identified IGFBP1 as an independent risk factor,and prognostic analysis suggested that IGFBP1 was closely associated with bleak prognosis.GO analysis indicated that IGFBP1-related differential genes were enriched in positive regulation of cell adhesion,vesicle lumen,and serine hydrolase activity;while KEGG analysis suggested that they were enriched in IL-17 signaling pathway.The analysis of tumor-associated immune cell infiltration showed significant differences in immune cell infiltration between high and low IGFBP1 expression groups.IGFBP1 related gastric cancer prognosis model was constructed using univariate Cox and LASSO regression analyses.Seven core genes were identified in PPI network,enriching in cholesterol metabolism,pyrimidine metabolism,and PPAR signaling pathway.The expression level of IGFBP1 was correlated with the sensitivity to Dasatinib and other drugs.Conclusion The up-regulated expression of IGFBP1 in gastric cancer leads to poor prognosis,which may regulate the occurrence and development of gastric cancer by affecting IL-17 signaling pathway and M0 macrophage infiltration.

Influenza is a major threat to millions of people worldwide. Vaccines and antiviral agents are two main options available to reduce the impact of the influenza virus, while anti-influenza agents are the most effective means to prevent the transmission of the highly contagious virus and to treat the epidemics of disease. At present, four anti-influenza agents have been approved by the FDA for the treatment of influenza, including two M2 protein ion channel inhibitors-amantadine and rimantadine and two neuraminidase inhibitors-zanamivir and oseltamivir. Arbidol hydrochloride, launched in Russia, is a potent inhibitor of influenza virus, too. Neuraminidase inhibitors could be classified generally by structure into six different kinds: sialic acid derivatives, benzoic acid derivatives, cyclohexene derivatives, cyclopentane derivatives, pyrrolidine derivatives and natural products. In this paper, recent progress in the research of the action mechanisms and structure-activity relationships of these anti-influenza virus agents were reviewed.
Amantadine ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Antiviral Agents ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Cyclopentanes ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Guanidines ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Humans ; Indoles ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Influenza, Human ; drug therapy ; Neuraminidase ; antagonists & inhibitors ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Orthomyxoviridae ; drug effects ; Oseltamivir ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Pyrrolidines ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Rimantadine ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Structure-Activity Relationship ; Viral Matrix Proteins ; antagonists & inhibitors ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use ; Zanamivir ; chemical synthesis ; chemistry ; pharmacology ; therapeutic use

?AlM: To investigate repeatability and accuracy of a latest Keratograph for evaluating the tear film stability and to compare its measurements with that of traditional examination methods.
?METHODS: The results of noninvasive tear film break-up time ( Nl-BUT ) including the first tear film break-up time ( BUT-f ) and the average tear film break-up time ( BUT - ave ) were measured by Keratograph. The repeatability of the measurements was evaluated by coefficient of variation ( CV ) and intraclass correlation coefficient ( lCC) . Wilcoxon Signed-Rank test was used to compare Nl-BUT with fluorescein tear film break-up time ( FBUT) to confirm the correlation between Nl-BUT and FBUT, Schirmer l test values. Bland-Altman analysis was used to evaluate consistency.
?RESULTS: The study recruited 48 subjects ( 48 eyes ) (mean age 38. 7±15. 2 years). The CV and lCC of BUT-f were respectively 12. 6% and 0. 95, those of BUT-ave were 9. 8% and 0. 96. The value of BUT-f was lower than that of FBUT. The difference had statistical significance ( 6. 16±2. 46s vs 7. 46±1. 92s, P<0. 01). There was significant positive correlation between Nl-BUT and FBUT, Schirmer l test values ( P< 0. 01 ). The scope of 95% limits of agreement (LoA) was 4. 46s in BUT-f and FBUT, while the scope of LoA was 3. 64s in BUT-ave and FBUT.
?CONCLUSlON: Keratograph can provide Nl-BUT data that has a better repeatability and reliability, which has great application prospects in diagnosis and treatment of dry eye and refractive corneal surgery.

Objective To establish a rapid fluorescent inhibition test (RFFIT) for testing rabies virus neutralizing antibody and the titer of rabies virus neutralizing antibody.CVS-11 was used as the standard challenge virus,and three generations prepared for the establishment of the virus library.Methods International standard for rabies immunoglobulin was used as the reference serum.RFFIT test was established under consulting the protocol of Institute of Pasteur,and its specificity,stability and reproducibility were validated.Results We established the RFFIT which showed both good specificity ( 100% ) and reproducibility (P＞0.5).Conclusion The establishment of RFFIT test perfected the rabies laboratory techniques and would enhance the overall ability in detecting rabies in China.

Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.

Abnormalities, Multiple ; diagnosis ; surgery ; Anus, Imperforate ; surgery ; Colon ; abnormalities ; Female ; Follow-Up Studies ; Humans ; Infant, Newborn ; Ischium ; abnormalities ; Treatment Outcome ; Twins, Conjoined ; surgery

BACKGROUNDGreat advances have been made in the diagnosis, molecular pathogenesis and treatment of acute lymphoblastic leukemia (ALL) in the past decade. Due to the lack of large population-based studies, the recent trends in the incidence and geographic variations of ALL in Shanghai, China have not been well documented. To better understand the incidence and epidemiological features of ALL in Shanghai, we conducted a retrospective survey based on the database from the Shanghai Center for Disease Control and Prevention (CDC) and the medical records in all large-scale hospitals in Shanghai, especially those 30 major hospitals with hematology department.

METHODSAccording to the data from Shanghai CDC, 544 patients, with a median age of 32 years (ranging 1.2 - 89 years), were diagnosed as de novo ALL from January 1, 2002 to December 31, 2006, and they were followed up until December 31, 2007.

RESULTSThe average annual incidence of ALL in Shanghai was 0.81/100 000. The incidence in men (0.86/100 000) was slightly higher than that in women (0.75/100 000). The age-stratified incidence showed that the incidence was 2.31/100 000 in patients ≥ 17 years old, 0.54/100 000 in those 18 - 34 years old, 0.46/100 000 in those 35 - 59 years old, and 0.94/100 000 in those ≥ 60 years old. Moreover, there were substantial geographic variations in the incidence of ALL, with the incidence in Chongming county, an island in the east of Shanghai city being 0.60/100 000, much lower than those of other districts. Both French-American-British (FAB) and World Health Organization (WHO) classification systems were applied in the present study. Eighty-eight patients were diagnosed as L1 (26.2%), 193 L2 (57.4%), and 55 L3 (16.4%). For 302 patients with immunophenotypic results, 242 were identified as B cell origin (80.1%), 59 as T cell origin (19.5%), and 1 as biphenotype (0.4%). The leukemia cells in 61 patients co-expressed one or two myeloid antigen (20.2%). For 269 patients with cytogenetic results, the incidences of t(9;22) in patients aged < 10, 11 - 17, 18 - 44, 45 - 59 and ≥ 60 years old were 4.2%, 11.4%, 19.2%, 23.1% and 5.3%, respectively.

CONCLUSIONCompared with the previous data, the incidence of ALL is increased in Shanghai, and has a geographic distribution characteristic.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Data Collection ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; epidemiology ; Young Adult

OBJECTIVETo determinate the clinicopathologic parameters in predicting the malignant behavior of gastrointestinal stromal tumor (GIST).

METHODSEight hundred and forty cases of GIST were retrospectively reviewed. The tumors were classified as malignant if they met any of the following criteria: evidence of gross dissemination (including liver metastasis and/or peritoneal spread), evidence of microscopic dissemination (including lymph node metastasis, infiltration to vessels, fat tissue, nerves and/or mucosal tissue), or disease relapse. The remaining cases were provisionally classified as tumors of uncertain biologic behavior. A number of morphologic parameters were then evaluated under light microscopy and univariate and multivariate analyses were adopted for this study.

RESULTSHistologic findings correlated with evidences of the following morphologic parameters were considered in accord with the criteria of the malignant behavior: mitotic count>or=10 per 50 high-power fields (P<0.01), muscle infiltration (P<0.01), coagulative necrosis (P<0.01), perivascular growth pattern (P=0.005) and remarkable nuclear atypia (P=0.014). Basing on the above criterion, 485 cases were re-classified as "malignant" and 355 cases "non-malignant". Follow-up data showed that the five-year disease-free survival and overall survival in the "non-malignant" group were 99.3% and 100% respectively, in contrast to 43.9% and 59.7% respectively in the "malignant" group (P<0.01).

CONCLUSIONSThe set of clinicopathologic parameters is useful in predicting the malignant behavior of GIST and prognosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; classification ; pathology ; Humans ; Liver Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Peritoneal Cavity ; pathology ; Retrospective Studies ; Risk Assessment ; Survival Rate ; Young Adult

Objective To investigated the effect and safety of Bozi glyco-peptide joint ascites reinfusion in the treatment cirrhosis conbined with pontaneous bacterial peritonitis.Methods A total of 56 cases of cirrhotic patients with spontaneous bacterial peritonitis were selected and divided into two groups.The control group (28 cases) were treated with ascites reinfusion while experiment group ( 28 cases ) were treated with Bozhi glycopeptide 4 mL joint ascites reinfusion for two weeks.Lipopolysaccha-ride -binding protein, tumor necrosis factor -αand procalcitonin levels, liver function, complications were observed before and after treat-ment.Results Lipopolysaccharide -binding protein, tumor necrosis factor -αand procalcitonin levels of two groups patients all obviously re-duced ( P <0.05 ) , and those of experiment group were significantly lower than the control group ( P<0.05).Alanine aminotransferase levels of two groups obviously reduced with albumin levels increased ( P<0.05) , and alanine aminotransferase of the experiment group was significantly lower than that of control group, the albumin level was higher ( P <0.05 ) . Total effective rate of the experiment group ( 82.14%) were significantly higher than that of control group (53.57%) (P<0.05).The complication rate of the experiment group (7.14%) were significantly lower than that of control group (32.14%) (P<0.05).Conclusion Bozhi glycopeptide joint ascites reinfusion can effectively treat cirrhosis combined with spontaneous bacterial peritonitis and improve clinical symptoms that can not only improve treat-ment but also be safe.