Objective To investigate the effect of dexmedetomidine ( Dex) combined with ropivacaine in brachial plexus block ( BPB) on serum basic fibroblast growth factor ( bFGF) levels of upper limb fracture patients in the perioperative period. Methods 80 patients ( ASA gradeⅠ~Ⅱ) scheduled for selective upper extremity surgery were randomly divided into the dexmedetomidine combined with ropiva-caine group ( RD group) and the ropivacaine group ( R group) with 40 patients in each group. BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine (200 mg) was diluted into 40 mL in group R and ropivacaine (200 mg) +1 μg/kg dexmedetomidine were diluted into 40 mL in group RD. Drew 5 mL blood at T0~T4 points respectively,and serum bFGF concentration were determined. Results Compared with group R,MAP and HR at T1~T3 points were significantly lower in group RD (P<0. 05). SpO2 in the two groups at each point had no statistical significance (P>0. 05). Compared with T0 points,bFGF concentration were increased in two groups at T1~T4 points (P<0. 05),and it was higher in group RD compared with group R (P<0. 05). Conclusion Dex combined bra-chial plexus block promote the secretion of bFGF more than simple brachial plexus block,which is conducive to fracture healing after opera-tion,but it should be cautious to apply for patients with bradyarrhythmia.

Objective: To develop a scoring system for estimating advanced colorectal neoplasm risk in average-risk population in southern Jiangsu province, and to evaluate its screening efficiency. Methods: An average-risk population of colorectal neoplasm in southern Jiangsu province, who underwent colonoscopy, was included in this study. All participants were asked to complete a questionnaire on demographic characteristics, medical history, smoking, alcohol consumption, dietary intake, and other factors that may be associated with advanced neoplasms. A multivariable logistic regression method was used to identify independent predictors of advanced neoplasms. A scoring system was developed from the logistic regression model by using a regression coefficient-based scoring method, and then was internally validated. The screening efficiency of the scoring system was assessed by its calibration, discrimination, and accuracy. Results: A total of 905 average-risk participants were included in this study. The scoring system comprised 5 variables (age, sex, coronary artery disease, egg intake, and defecation frequency), with scores ranging from 0 to 10. The system had good calibration (P= 0.205) and good discrimination (area under the receiver operating characteristic curve = 0.75, 95% confidence interval: 0.69-0.82). If score 2.5 was used as the screening cut-off value, the sensitivity, specificity, accuracy rate, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 93.8%, 47.6%, 50.1%, 9.1%, 99.3%, 1.79, and 0.13, respectively. Among the participants with low-risk (0-2) or high-risk (>2) scores, the risks of advanced neoplasms were 0.7% and 9.1% (P<0.001), respectively. If colonoscopy was used only for persons with high risk, 93.8% of persons with advanced neoplasms would be detected while the number of colonoscopies would be reduced by 45.4%. Conclusion: The scoring system in this study has satisfactory screening efficiency and can be used for preliminary screening of advanced colorectal neoplasms in average-risk population in southern Jiangsu Province.

Objective: To evaluate the primary outcomes and adverse reactions of patients with hepatocellular carcinoma treated by stereotactic body radiation therapy (SBRT) using tomotherapy. Methods: From December 2012 to December 2015, Forty-six patients with hepatocellular carcinoma who received SBRT in Zhongshan Hospital Affiliated to Fudan University were enrolled. The clinical and pathological data and follow-up data of all cases were collected. The median diameter of tumors was 2.5 cm, ranging from 0.9 to 5.8 cm. All cases were performed by four-dimensional CT (4-DCT) scan and image-guided matching calibration before SBRT. Total irradiation dose ranged from 48 to 50 Gy in 5 to 10 fractions. The supportive treatments of liver protection and nutritional support were administrated during SBRT. The curative tumor response was evaluated using the modifed Response Evaluation and Criteria in Solid Tumors (mRECIST) 6 months after SBRT. The adverse reactions were evaluated using National Cancer Institute- Common Terminology Criteria for Adverse Events 3.0 (NCI-CTC 3.0). The cumulative probability of survival was calculated according to Kaplan-Meier method. Results: All cases completed SBRT. They were followed up every 3 months after treatment. Based on mRECIST, 58.7% of patients achieved complete response (CR), 32.6% achieved partial response (PR), and there were 4.3% patients with stable disease, and 2.61% patients with tumor progression. The total effective rate (CR+PR) was 91.3%. The overall survival (OS) rates at 1, 2 and 3 years were 95.4%, 75.7% and 69.9%, respectively. For the adverse reaction, only 5 cases of grade? bone marrow suppression, 2 cases of gradeII bone marrow suppression and 2 cases of grade? transaminase increase were found; no radiation-induced liver disease (RILD) occurred. Conclusion: Tomotherapy is a safe and effective treatment for the patients with unresectable hepatocellular carcinoma. So SBRT using tomotherapy is worth promoting as an alternative treatment for unresectable hepatocellular carcinoma unsuitable for standard treatment.

AIM: To investigate the effects of dehydroepiandrosterone (DHEA) on experimental osteoarthritis in rats. METHODS: Forty rats were randomly divided into four groups. Group A is normal control group. Osteoarthritic models of rats were established by intraarticular injections of papain into the right knee joints of groups B, C and D. Then the right knee joints of rats in groups C and D, respectively, received 150 ?l intraarticular injections of DHEA at a concentration of 50 ?mol?L~(-1) and 100 ?mol?L~(-1), and the right knee joints of rats in groups A and B both received 150 ?l physiological saline, twice weekly for five weeks. Six weeks later, all rats were sacrificed, and the articular cartilage was assessed by gross morphologic, histologic, biochemical and immunohistochemical methods. RESULTS: The cartilage damage in groups C and D was much less than that in group B through observation under a surgical microscope. The Mankin's score, nitric oxide (NO) in the douche of articular cavity, malondialdehyde (MDA) in synovium, the expression of matrix metalloproteinase-1 and 9 in articular cartilage in groups C and D decreased in comparison with group B, and the foregoing indexes in group D decreased significantly compared with group C. However, the activities of superoxide dismutase (SOD) in the douche of articular cavity and blood serum in groups C and D increased in comparison with group B, and the foregoing indexes in group D increased significantly compared with group C. CONCLUSIONS:DHEA shows a cartilage-protecting effect which is in a dosage-dependent manner. The mechanism probably is to inhibit the expression of matrix metalloproteinases and to decrease the release of (NO and enhance the antioxidation.

OBJECTIVETo investigate the effect of decitabine (DAC) alone or in combination with arsenic trioxide (AsO) on the proliferation and apoptosis of human acute myeloid leukemia (AML) MV4-11 cells, so as to find an effective method for treating AML with MLL rearrangements.

METHODSThe inhibitory effect of DAC and AsOalone, as well as in a combination of less than 50% inhibitory concentration (IC) of DAC, and with less than 20% inhibitory concentration (IC) AsOon MV4-11 cell proliferation were detected by CCK-8 methed; and the apoptosis inducing effect was determined by flow cytometry.

RESULTSThe inhibitory effect of DAC or AsOalone on the cell proliferation increased along with the augment of drug concentration in a dose-dependent manner, both were statistically significant (P<0.01) in comparison the control group. The ICof DAC and AsOon MV4-11 cells were 2.409 µmol/L and 2.364 µmol/L, respectively. When compared with DAC alone in the same concentration gradient, the combined chemotherapy of DAC(0.01, 0.1, 0.5, 1 µmol/L) and AsO(0.25 µmol/L) showed higher inhibitory effect on cell proliferation and there was statistically differences (P<0.05). The 48 h apoptotic rate of DAC (5.0 µmol/L) on MV4-11 was 13.50%±1.87%; and the 48 h apoptotic rate of AsO(2 µmol/L) was 12.60%±2.33%; while the 48 h apoptotic rate in combination of 2 drugs was 51.13%±4.97%.

CONCLUSIONDAC or AsOcan remarkably inhibit MV4-11 cell proliferation and induce apoptosis, and the combination of two drugs displays a synergistic effect.

This study was purposed to investigate the expression of miR-16 in T lymphoblastic lymphoma/acute lymphoblastic leukemia (T-LBL/ALL) and its relation with target therapy and prognosis. The CD3, cCD3, CD10, CD20, CD34, CD43, CD99, TdT, PAX-5, BCL-2 and Ki67 in paraffin samples from 38 cases of T-LBL/ALL were detected by immunohistochemical labeling; the miR-16 expression level was detected by real-time RT-PCR. Fifteen cases of reactive hyperplasia of lymph nodes were selected as control. The results indicated that among 38 cases of T-LBL/ALL the positive rate of TdT was highest (94.7%), the positive rate of CD34 was lowest (22.1%), the PAX-5 and CD20 were found to be negative. The Ki67 expression level in 39.5% cases exceeded 80%. As compared with reactive hyperplasia of lymph node, the miR-16 expression in T-LBL/ALL was up-regulated, ant its expression level was 4.87-fold of reactive hyperplasia of lymph node (P < 0.05). The overall survival rate in group of miR-16 high expression decreased (P < 0.05). The prognosis of T-LBL/ALL patients with BCL-2 positive expression was better than that of patients with BCL-2 negative expression (P < 0.05). The miR-16 expression correlated with BCL-2 protein (r = 0.51, P < 0.05). It is concluded that the overall survival rate in miR-16 high expression group is higher than that in miR-16 low expression group, suggesting possible relation of miR-16 with prognosis. Moreover, the prognosis in BCL-2 positive expression group is better than that in negative expression group, which may be a factor influencing prognosis.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; MicroRNAs ; genetics ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; Prognosis ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; Survival Rate ; Young Adult

OBJECTIVE: To identify the optimal factors in diffusion tensor imaging for predicting corticospinal tract (CST) injury caused by brain tumors. MATERIALS AND METHODS: This prospective study included 33 patients with motor weakness and 64 patients with normal motor function. The movement of the CST, minimum distance between the CST and the tumor, and relative fractional anisotropy (rFA) of the CST on diffusion tensor imaging, were compared between patients with motor weakness and normal function. Logistic regression analysis was used to obtain the optimal factor predicting motor weakness. RESULTS: In patients with motor weakness, the displacement (8.44 ± 6.64 mm) of the CST (p = 0.009), minimum distance (3.98 ± 7.49 mm) between the CST and tumor (p < 0.001), and rFA (0.83 ± 0.11) of the CST (p < 0.001) were significantly different from those of the normal group (4.64 ± 6.65 mm, 14.87 ± 12.04 mm, and 0.98 ± 0.05, respectively) (p = 0.009, p < 0.001, and p < 0.001). The frequencies of patients with the CST passing through the tumor (6%, p = 0.002), CST close to the tumor (23%, p < 0.001), CST close to a malignant tumor (high grade glioma, metastasis, or lymphoma) (19%, p < 0.001), and CST passing through infiltrating edema (19%, p < 0.001) in the motor weakness group, were significantly different from those of the patients with normal motor function (0, 8, 1, and 10%, respectively). Logistic regression analysis showed that decreased rFA and CST close to a malignant tumor were effective variables related to motor weakness. CONCLUSION: Decreased fractional anisotropy, combined with closeness of a malignant tumor to the CST, is the optimal factor in predicting CST injury caused by a brain tumor.
Anisotropy ; Brain Neoplasms* ; Brain* ; Diffusion Tensor Imaging* ; Diffusion* ; Edema ; Glioma ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prospective Studies ; Pyramidal Tracts*

Objective To investigate the regulating function of human gingival mesenchymal stem cell (GMSC) on the proliferation and differentiation of B cells and its underlying molecular mechanism. Methods GMSC were isolated and B cells were isolated from peripheral blood. GMSC or fibroblasts were co-cultured with B cells in vitro and assigned into the GMSC group and fibroblast group. The proliferation of B cells was detected in two groups. The expression of IgG1 and IgM in the cell supernatants was measured between two groups. The secretion of interleukin (IL)-6, Perforin, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was compared between two groups. The expression levels ofIL-10 and transforming growth factor (TGF)-β in B cells were detected between two groups. The expression of PC-1 in B cells was measured in two groups. The signaling pathway involved with the regulating effect of GMSC on B cell function was investigated. The regulating effect of GMSC on the role of B cells in activating T cell function was assessed. Results Compared with the fibroblast group, the proliferation of B cells was significantly weakened in the GMSC group (P < 0.05). Co-culture of GMSC and B cells significantly inhibited the secretion of IgG1 and IgM from B cells and the secretion ofIL-6, Perforin, IFN-γ and TNF-α (all P < 0.05). Compared with the fibroblast group, the secretion of IL-10 and TGF-βwas significantly higher in the GMSC group (both P < 0.05). The expression level of PC-1 in the GMSC group was significantly down-regulated (P < 0.05). After adding ALK5, an inhibitor of TGF-β receptor, the inhibitory effect of GMSC upon B cells was significantly weakened (P < 0.05). Compared with the fibroblast group, the ability of B cells to activate and proliferate T cells was significantly attenuated in the GMSC group (P < 0.05). Conclusions GMSC can inhibit B cells and their mediated immune responses. The activation of B cells and other related functions can be suppressed through the TGF-β signaling pathway.

Objective To investigate the efficacy and toxicity of conventional fractionated three-dimensional conformal radiotherapy (3D-CRT) on unresectable hepatocelluar carcinoma(HCC).Methods Fifty two patients with unresectable HCC,all without extrahepatic metastases,were treated by 3D-CRT conducted 5 times a week with the total radiation dose of 36-66 Gy and a daily dose of 2 Gy.The curative effect was evaluated by CT scan to observe the maximum tumor size.Survival rates,survival time,and adverse responses were recorded.Results The total effective rate of the 52 patients was 69.2％ with complete response (CR) in 2 patients and partial response (PR) in 34 patients.The incidence rate of radioactive hepatitis was 1.92％.The 1-,2-,3-,and 4-year survival rates were 57.7％,34.6％,23.1％,and 9.61％ respectively,and the median survival time was 10.5 months.The 1-,2-,3-,and 4-year local control rates were 67％,51.5％,32.3％,and 2.24％,and the 1-,2-,3-,and 4-year distant metastasis rate were 17.2％,23.5％,36.7％,and 76.9％ respectively.The intrahepatic metastases rate was 62.5％ and 37.5％ of the patients suffered from extrahepatic metastasis,including metastases of lung,bone,and retroperitoneal lymph nodes.The remission rate of the≥50 Gy group was 76.9％,significantly higher than that of the ≤50 Gy group (46.2％,x2 =10.72,P ＜ 0.05 ).There was no grade 3 or 4 acute toxicity,and two patients (3.84％) developed gastric or duodenal ulcer.Conclusions Conventional fractionaled 3D-CRT evokes a rather effective response for unresectable HCC with acceptable toxicity.Radiation dose seems to be a significant prognostic factor in RT response for HCC.

This study was aimed to investigate the expression of blood Th17 and CD4(+) CD25(+) regulatory T cells (Treg) in the patients with aplastic anemia (AA). Forty-five patients with AA were enrolled into this study, and were divided into mild aplastic anemia (MAA) group (n = 25) and severe aplastic anemia group (SAA) (n = 20), blood cell count was recorded. 15 healthy donors were enrolled as control. Proportions of blood Th17 and CD4(+) CD25(+) Treg cells were determined by flow cytometry. The serum levels of IL-17, IFN-γ and TNF-α, as well as their concentrations in culture supernatant of phytohemagglutinin (PHA) -stimulated peripheral blood mononuclear cells, were measured by ELISA. The results showed that the proportions of blood Th17 cells and concentration of blood serum IL-17 and IFN-γ increased in patients with SAA, compared with MAA and normal controls, but CD4(+) CD25(+) Foxp3(+) Treg cells obviously decreased in patients with SAA. The concentrations of IL-17 and IFN-γ significantly increased in culture supernatant of SAA group. Hemoglobin level in the patients with AA negatively correlated with the population of Th17 cells and serum IL-17 level, whereas positively correlated with the expression of CD4(+) CD25(+)Treg cells. It is concluded that the increased response of Th17 cells and deficiency of CD4(+) CD25(+) Treg cells present in severe aplastic anemia. The severity of anemia may be related with the imbalance between Th17 and CD4(+) CD25(+)Treg cell response.
Adult ; Aged ; Anemia, Aplastic ; blood ; metabolism ; Case-Control Studies ; Female ; Humans ; Interferon-gamma ; blood ; Interleukin-17 ; blood ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; T-Lymphocytes, Regulatory ; metabolism ; Th17 Cells ; metabolism ; Tumor Necrosis Factor-alpha ; blood ; Young Adult