Twenty days after the operation of anterior cervical decompression fusion with internal fixation, the fistula was found at the lower end of right neck incision with purulent secretion, the intumescent mucosa was founded at the posterior wall of the esophagus, down about 5 cm of the oesophagostomum. The metal plate sample exposed under the intumescent mucosa. The diagnosed was "neck esophageal fistula".
Decompression, Surgical ; Esophageal Fistula ; surgery ; Humans ; Neck

Objective To evaluate the vaccine effectiveness ( VE) in children who received one dose of live attenuated varicella vaccine. Methods A questionnaire-based 1 ∶ 2 matching case-control study was conducted during May, 2015 to April, 2016 to evaluate the VE based upon the demographic data, vacci-nation status and clinical symptoms of 127 children with varicella and 254 healthy subjects under 12 years old. Results Compared with the healthy subjects, 83. 46% of the patients with varicella were immunized with one dose of varicella vaccine, which was lower than that of the control group (90. 55%) (χ2=4. 08, P<0. 05). The overall protective rate of one dose of varicella vaccine reached 64. 29% (95% CI:42. 00%-78. 00%). Of the 127 cases of varicella, 83. 46% were breakthrough cases immunized with one dose of var-icella vaccine. Primary cases presented more severe clinical symptoms than breakthrough cases. The longer the interval between vaccination and varicella-zoster virus infection was, the more severe the breakthrough cases would be. Conclusion Varicella vaccine is effective for preventing varicella, but the VE of one dose of varicella vaccine is limited. A two-dose varicella vaccination strategy should be proposed in our country as soon as possible.

Objective A method was developed for the simultaneous determination of tryptophan(Trp) and its metabolites kynurenine(Kyn) and kynurenic acid(Kyna) by high performance liquid chromatography with fluorescence detection(HPLC-FD),and testing serum levels of Trp metabolites in systemic lupus erythematosus(SLE) patients.Methods Serum samples were deproteinized by equal volume of 0.624 mol/L perchloric acid.The analytical column was Hypersil C18 column,and the mobile phase was 0.20 mol/L zinc acetate,8.3 mmol/L acetic acid,and 2.5% acetonitrile;flow rate was 1.5 ml/min.The excitation and emission wave length of fluorescence detector were 365 nm and 480 nm in 0~11 min,344 nm and 404 nm in 11~15.5 min,254 nm and 404 nm in 15.5~20 min,respectively.Results The linear range of Trp was 0.610~196 ?mol/L,the detection limit was 0.005 ?mol/L,and the average recovery was 103.71%.The linear range of Kyn was 0.049~98 ?mol/L,the detection limit 0.025 ?mol/L,and the average recovery was 97.45%.The linear range of Kyna was 1.050~1047 ?mol/L,the detection limit was 0.050 nmol/L,and the average recovery was 100.60%.Inter-and intra-day precisions were both less than 5%.Phenylalanine,tyrosine,and 5-hydroxytryptamine had no interference.The assay was employed to analyze serum samples of SLE patients.The result showed significant difference in Trp,Kyn,and Kyna content,Kyn/Trp ratio between SLE patients and control group.Conclusions A new method was established for simultaneous determination of Trp,Kyn,and Kyna in serum.The method is simple,fast,sensitive,specific,and suitable for applicability to clinical measurement.

Objective To compare the effects of isoflurane or sevoflurane in combination with remifentanil anesthesia on blood amyloid beta protein (Aβ) in the elderly patients undergoing abdominal surgery.Methods Two hundred patients of both sexes,aged 65-75 yr,weighing 51-76 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective abdominal surgery under general anesthesia,were randomly divided into 2 groups (n =100 each) using a random number table:isoflurane combined with remifentanil anesthesia group (IR group) and sevoflurane combined with remifentanil anesthesia group (SR group).Fifty healthy elderly subjects served as control group (group C).After anesthesia was induced with iv penehyclidine,sufentanil,propofol and vecuronium,the patients were endotracheally intubated and mechanically ventilated.In group IR,anesthesia was maintained with inhalation of isoflurane (end-tidal concentration 1.68 ％,in IR group) or sevoflurane (end-tidal concentration 1.71％,in SR group),and target-controlled infusion of remifentanil (target plasma concentration 2-6 ng/ml).At l day before surgery and 3 days after surgery,the patients' cognitive function was assessed using Mini-Mental State Examination (MMSE),the development of postoperative cognitive dysfunction (POCD) was recorded,and blood samples were taken for determination of serum Aβ40 and Aβ42 concentrations.Results The incidence of POCD was 5％ (in C group),56％ (in IR group) or 22％ (in SR group),and there was no significant difference among the three groups.There were no significant differences in the serum Aβ42 and Aβ40 concentrations after surgery among the three groups.Conclusion The mechanism by which sevoflurane or isoflurane in combination with remifentanil anesthesia results in POCD is not related to the levels of blood Aβ40 or Aβ42 in the elderly patients undergoing abdominal surgery.

Background and purpose:Ovarian cancer-associated ifbroblasts (CAF) are known to promote epithelial malignancy. The chemoattractant cytokine growth-regulated oncogene alpha (Gro-α) secreted from CAF has been reported to mediate the stroma-epithelia interaction in tumor microenvironment, leading to the development of epithelial ovarian cancer, however, the detailed mechanism is unknown.This study was to determine whether Gro-αcould promote ovarian tumorigenesis through activating NF-кB nuclear translocation and VEGF expression in stromal ifbroblasts. Methods:ELISA was used to measure the levels of Gro-αin two cancer-associated ifbroblasts (CAF) and normal ifbroblasts (NF) isolated from high-grade serous ovarian cancer or normal ovarian tissues. CAF conditioned medium (CM) or Gro-αwas used to treat NF, while PS1145, the inhibitor of NF-кB, was used as control. NF-кB subunit p65 and vascular endothelial growth factor (VEGF) were detected by Western blot in cells after treatment. Xenograft tumors from nude mice were generated by injection of CAF, NF, or OVCA429 alone or OVCA429 mixed with CAF or NF, and by injection of OVCA429 mixed with NF cells that were treated with or without CAF-CM or Gro-α, or with NF cells that were treated with CAF-CM or Gro-αplus PS1145. The tumor growth curve was measured and the blood vessel density in xenograft tumor tissues was examined by histopathological analysis. Results:The levels of Gro-αwere 5-6 folds higher in CAF than in NF. Treatment of NF with CAF-CM or Gro-αstimulated the nuclear translocation of NF-кB subunit p65, and the expression of VEGF, but suppressed the expression of thrombospondin 1, the anti-angiogenesis factor, compared with control cells. However, treatment of NF with the NF-кB inhibitor PS1145 reversed these results. The animal assay revealed that CAF stimulated tumor growth stronger than NF, and NF treated with CAF-CM or Gro-α, but not along with PS1145, enhanced xenograft tumor growth through promoting angiogenesis. Conclusion:Ovarian CAF promotes the nuclear translocation of NF-кB and the expression of VEGF through Gro-αautocrine in tumor microenvironment to facilitate angiogenesis and ovarian cancer development.

Background and purpose: Cancer-associated fibroblasts (CAFs) are known to promote the invasion and metastasis of epithelial cancers. The cytokine IL-6 may mediate the interaction between stromal cells and epithelia in tumor microenvironment to facilitate the invasiveness and metastasis of cancer, however, such mechanism has not been fully covered yet.Methods:We used cervical cancer cell line HeLa as a model for this study. ELISA was used to measure the levels of IL-6 in CAFs and normal ifbroblasts (NFs) isolated from squamous cervical cancer or normal cervical tissues. CAFs conditioned medium or IL-6 was used to treat cervical cancer HeLa cell line. The epithelial-mesenchymal transition (EMT) markers such as N-Cadherin and Vimentin were detected by Western blot in cells before and after treatment. Scratches and transwell chambers were used to test the abilities of cell migration and invasion. Results:The levels of IL-6 were 4-5 folds higher in CAFs than in NFs. Treatment of HeLa cells with CAF conditioned medium or IL-6 upregulated N-Cadherin and Vimentin, but down-regulated E-Cadherin and cytokeratin, compared with control cells, indicating that IL-6 may stimulate HeLa cells to EMT. Further study found that Snail 1, the featured transcription factor for stem cells, was increased along with the enhanced phosphorylation of STAT3. Meanwhile, the migration and invasion of HeLa cells treated with IL-6 or CAF conditioned medium were markedly increased. Conclusion:CAF induces the EMT of cervical epithelial cancer cells through IL-6/STAT3/Snail pathway, which thereby promotes the invasiveness and metastasis cervical epithelial cancer.

Objective To establish a sandwich enzyme linked immunosorbent assay (ELISA) method for determination of von Willebrand factor propeptide (vWF-pp) in plasma and to determine the levels of plasma vWF-pp in 152 healthy volunteers, 36 patients with coronary heart disease and 38 cases of the normal control group with the same ages.Methods The levels of vWF-pp in 152 healthy volunteers with different ages and different genders and in 36 patients with coronary heart disease were determined with the sandwich enzyme linked immuno-sorbent assay (ELISA).Results The average level of vWF-pp in 152 healthy volunteers was 496.4?167.2 ?g/L.The level of vWF-pp in the 50~60 years old group was significantly higher than that in the less than 40 years old group (P0.05). There was significant difference between the 51～60 years old male group and the other three male groups respectively, the 16～20 years old group, the 21～30 years old group and the 31～40 years old group (P

ABSTRACT:Objective To observe the influence of saikosaponin-d (SSd)on the proliferation and the function of autophagy of human hepatocellular carcinoma (HCC)cell line SMMC-7721 to explore the possible mechanisms. Methods SMMC-7721 was cultured invitro and then treated with SSd of various concentrations (5.0,7.5,10.0, 12.5,15.0 and 17.5 mg/L)for 24,48 and 72 h.We used MTT to detect cell proliferation,selected the optimal concentration and time,and detected the expressions of BECN1 at mRNA and protein levels by PCR and Western blot.Results The inhibition rate of the proliferation of SMMC-7721 cell line increased with the increase of the concentration of SSd,and the highest inhibition rate (60%)appeared when the concentration reached 12.5 mg/L. The expression of BECN1 in the group with SSd was obviously higher than that in the control group (P<0.05). 3-MA decreased not only the expressions of BECN1 at mRNA and protein levels but also the expression of BECN1 when used in conjunction with SSd.Conclusion The inhibiting function of SSd on SMMC-7721 presents a dependency between drug concentration and function time,basically in line with the drug dose-effect relationship. SSd induces the occurrence of autophagic cell death through up-regulating the expression of BECN1 ,thus inhibiting the proliferation of SMMC-7 7 2 1 .

Objective To investigate serum IgG subclass concentrations in the adult population of Hunan region,and the effects of age,gender and lifestyle on them.Methods Serum IgG1,IgG2,IgG3,IgG4 and IgG concentrations from 170 adults making a health examination were detected by the immunonephelometric assay.Results The concentrations (mean or median [P25,P75]) of serum IgG1,IgG2,IgG3,IgG4 and IgG were (7.53 ± 0.14) g/L,3.99 (3.13,5.02) g/L,0.49 (0.30,0.70) g/L,0.53 (0.26,0.93) g/L and 12.2 (10.5,14.1) g/L,respectively.The serum IgG1/IgG,IgG2/IgG,IgG3/IgG and IgG4/IgG were (61.3 ±0.69)％,33.38％ (27.8％,38.8％),3.97％ (2.5％,5.3％) and 4.44％ (2.1％,7.3％),respectively.The serum IgG3 concentrations and IgG3/IgG ratios in female adults were significantly higher than that in male adults (P =0.005 and 0.014).However,there were no significant difference in serum IgG1,IgG2 and IgG4 concentrations and IgG1/IgG,IgG2/IgG and IgG4/IgG ratios between male and female adults.The serum IgG3 concentrations in the 31-40 years old adults were significantly higher than that in the 41-50 years old (P =0.03),while there were no significant difference in serum IgG1,IgG2 and IgG4 concentrations between different age groups.The serum IgG1 concentrations in the adults with heavy smoking were significantly lower than that without smoking (P =0.023),while the serum IgG4/IgG ratios were the opposite (P =0.018).The serum IgG1 and IgG3 concentrations and IgG3/IgG ratios in the adults with midrange or heavy drinking were significantly lower than that without ethanol consumption (P =0.05,0.004 and 0.015,respectively).The serum IgG3 concentrations and IgG3/IgG ratios in the adults with low-risk metabolism syndrome were significantly higher than that with the high-risk (P =0.034 and 0.038).Conclusion Gender and age have the significant effect on serum IgG3 concentration.Heavy smoking may reduce serum IgG1 concentration and increase IgG4/IgG ratio.The decrease of serum IgG1,IgG3 and IgG3/IgG may be related to ethanol consumption.

Background: To evaluate the feasibility of treating odontoid fractures in the Chinese population with two cortical screws based on computed tomography (CT) scans and describe a new measurement strategy to guide screw insertion in treating these fractures. Methods: A retrospective review of cervical computed tomographic scans of 128 patients (aged 18–76 years; men, 55 [43.0%]) was performed. The minimum external transverse diameter (METD), minimum external anteroposterior diameter (MEAD), maximum screw length (MSL), and screw projection back angle (SPBA) of the odontoid process were measured on coronal and sagittal CT images. Results: The mean values of METD and MEAD were 10.0 ± 1.1 mm and 12.0 ± 1.0 mm, respectively, in men and 9.2 ± 1.0 mm and 11.0 ± 1.0 mm, respectively, in women. Both measurements were significantly higher in men (p < 0.001). In total, 87 individuals (68%) had METD > 9.0 mm that could accommodate two 3.5-mm cortical screws. The mean MSL value and SPBA range were 34.4 ± 2.9 mm and 13.5°–24.2°, respectively, with no statistically significant difference between men and women. Conclusions The insertion of two 3.5-mm cortical screws was possible for anterior fixation of odontoid fractures in 87 patients (68%) in our study, and there was a statistically significant difference between men and women.