Objective To investigate the imaging characteristics of lymphoscintigraphy in postoperative breast cancer patients and evaluate its diagnostic value in breast cancer-related lymphedema (BCRL).Methods Seventy-nine breast cancer patients who underwent mastectomy and axillary lymph node dissection were studied. Patients ( n = 158 ) were divided into the study ( affected arms, n = 79 ) and control groups ( contralateral arms, n = 79). After subcutaneous injection of 99Tcm-dextran via the first interphalangeal space, lymphoscintigraphy was performed at 10 min, 1,3, 6 h respectively. Sensitivity and specificity of lymphoscintigraphy for detection of BCRL were calculated. Results There were significant differences in the amount of visualized lymph nodes, lymphatic integrity and backflow pattern between the two groups.Lymphatic drainage was preserved in 96.2% (76/79) of the contralateral arms and only 5.1% (4/79) of affected arms. 87.3% (69/79) and 74.7% (59/79) of control arms had ≥2 lymph nodes in axilla and supraclavicular regions, respectively; while none ( 0/79 ) and 5.1% (4/79) of the affected arms had ≥ 2lymph nodes in both regions, respectively. Four backflow patterns of radiotracer in subcutis were observed in the affected arms: normal (2.5% , 2/79), dilatated (55.7%, 44/79), diffused (36.7%, 29/79) and without backflow (5.1%, 4/79 ). The sensitivity and specificity of "lymphatic integrity" and "backflow pattern" on lymphoscintigraphy for detecting BCRL were 97.5% (77/79) and 96.2% (76/79), 94.8%(73/77) and 100.0% (81/81), respectively. Conclusion Lymphoscintigraphy is a noninvasive, accurate and effective imaging modality for the evaluation of BCRL.

OBJECTIVEThe clinical effect of the Shi's cervical reduction technique for cervical spondylosis and related disorders has confirmed, however, there were few studies on the body motion during manipulation in vivo study. This study is to summary the law of motion and the motion characteristics of the right operation shoulder, elbow, knee and ankle joints by data acquisition and analysis with the 3D motion capture system.

METHODSThe markers were pasted on the head, trunk, left and right acromion, elbow joint, wrist joint inner side and the outer side of the inner and the outer side and the lateral upper arm, forearm lateral, anterior superior iliac spine, posterior superior iliac spine, trochanter, femoral and tibial tubercle, inner and outer side of knee, ankle, fibular head, medial and lateral in first, 2,5 metatarsal head, heel and dual lateral thigh the calf, lateral tibia of one manipulation practioner, and the subject accepted a complete cycle of cervical "Jin Chu Cao and Gu Cuo Feng" manipulation which was repeated five times. The movement trajectory of the practioner's four markers of operation joints were captured, recorded, calculated and analyzed.

RESULTSThe movement trajectories of four joints were consistent, while the elbow joint had the biggest discrete degree. The 3D activities of the shoulder and elbow were more obvious than other two joints, but the degree of flexion and extension in the knee was significantly greater than the rotation and lateral bending.

CONCLUSIONThe flexibility of upper limb joint and stability of lower limb joint are the important guarantees for the Shi's cervical reduction technique, and the right knee facilitated the exerting force of upper limb by the flexion and extension activities. The 3D model built by the motion capture system would provide a new idea for manipulation teaching and further basic biomechanical research.

Adult ; Biomechanical Phenomena ; Cervical Vertebrae ; surgery ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Movement

Objective To evaluate the lymphoscintigraphic imaging characteristics for the patients with lower limb lymphedema and to establish a novel grading system for the injury to lower limb lymphatic system. Methods One hundred and sixty six consecutive patients (332 lower limbs) with lower limb lymphedema after surgical and(or) radiotherapy treatment for gynecological cancer were recruited into this retrospective study. The lymphoscintigraphy studies were performed after subcutaneous injection of 111～185 MBq (0. 1～0. 15 ml) of 99Tcm-DX into the webbed space between the first and second toes of both feet. Based on the integrity of lymphatic vessel and the extension of dermal diffusion on lymphoscintigram,the lymphatic injury to the lower limb was graded as 0, 1,2 and 3 respectively. The lymphedema of the limb was staged as 0, Ⅰ , Ⅱ a, Ⅱ b, Ⅲ by the standard of Consensus Document of the International Society of Lymphology (ISL). Chi square test was carried out to validate the established grading system for the assessment of the injury to the lower limb lymphatic system. Results The lymphoscintigraphic imaging characteristics included lymphatic blockage, dermal backflow, no visualization of lymphatic or lymph node, lymphocele and lymph fistula in the lower limb, pelvis and abdomen. There were 65 (19.6%), 71 (21.4%),131 (39.5%), 62 (18.7%) and 3 (0.9%) limbs staged as 0, Ⅰ , Ⅱa, Ⅱb, and Ⅲ for lymphedema while 36(10.8%), 79(23.8%), 116(34.9%) and 101 (30.4%) limbs graded as 0, 1, 2, and 3 for lymphatic injury. There was a statistically significant correlation between the grading methods (χ2 =313.483, P <0.001). The patients who underwent radiotherapy had a higher incidence rate of grade 2 and 3 (70.5%, 158/224) than those who underwent surgery (53.6%, 59/108) (χ2 = 9.662, P = 0.022).The patients with erysipelas had a higher incidence rate of grade 3(73.1%, 38/52) than those without erysipelas (43.9%, 50/114) (χ2= 12.238, P<0.001). The incidence rate of grade 3 increased with the duration of lymphedema after treatment: 36.6% (34/93) for less than 1.5 years, 72.3% (34/47) for between 1.5 to 5 years, and 76.9% (20/26) for more than 5 years (χ2 = 23.123, P<0.001). The grade of lymphatic injury showed no significant difference among 3 types of gynecological cancers (χ2 = 4.000, P =0.676), or between the patients with and without chemotherapy (χ2 =0.411, P=0.938). Conclusions Lymphoscintigraphy is a reliable modality to diagnose lower limb lymphedema after treatment for gynecological cancer. The injury grading system could provide objective assessment of the lymphatic damage.

OBJECTIVETo investigate the chemical constituents of dried whole plants of Artemisia annua.

METHODThe chemical constituents were isolated by repeated silica gel chromatography, medium pressure column chromatography, and semi-preparative HPLC, and their structures were elucidated by spectroscopic analyses and comparison of NMR data with those reported in literature.

RESULT15 compounds were isolated and identified to be 5-O-[(E)-Caffeoyl] quinic acid(l), 1,3-di-O-caffeoylquinic acid(2), 4 5-di-O-caffeoylquinic acid(3), 3, 5-di-O-caffeoylquinic acid (4), 3, 4-di-O-caffeoylquinic acid (5), methyl-3,4-di-O-caffeoylquinic acid(6), methyl-3,5-di-O-caffeoylquinic acid(7), 3,6'-O-diferuloylsucrose(8), 5'-β-D-glucopyranosyloxyjasmonic acid(9), Scopoletin(10), scoparone (11), 4-O-β-D-glucopyranosyl-2-hydroxyl-6-methoxyacetophenone (12), chrysosplenol D (13), casticin (14), chrysosplenetin(15).

CONCLUSIONCompounds 2, 6, 8 and 9 are obtained from the Artemisia genus for the first time. Compounds 7 and 15 are obtained from this plant for the first time.

Artemisia annua ; chemistry ; Chromatography, Gel ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; isolation & purification ; Flavonoids ; chemistry ; isolation & purification ; Medicine, Chinese Traditional ; Plants, Medicinal ; Quinic Acid ; analogs & derivatives ; chemistry ; isolation & purification ; Silica Gel

BACKGROUND AND OBJECTIVENasopharyngeal carcinoma (NPC) is known for its propensity for distant metastases. Lung metastasis is one of the most important causes of death for patients with NPC. Solitary metastatic lung tumor from NPC is a distinctive group associated with a better survival. This study was to find a more effective treatment modality and prognostic factors for the group.

METHODSClinical data of 105 cases of solitary metastatic lung tumor from NPC were retrospectively analyzed. Survival rate was calculated by the Kaplan-Meier method. The difference of survival between the patients treated by different modalities was evaluated by the log-rank test. The Cox univariate and multivariate analyses of gender, age, pathologic type, stage, adjuvant chemotherapy, evaluation of treatment for NPC, disease-free interval, size of metastatic tumor, pulmonary hilar and/or mediastinal lymph node metastasis, treatment modalities, recurrent distant metastases and/or relapse of NPC were conducted.

RESULTSThe local control rate was 53.8% in chemotherapy group, 88.0% in radiotherapy ± chemotherapy group, and 96.4% in operation ± chemotherapy group (P < 0.01). The most promising progression-free survival (PFS) and overall survival (OS) were obtained with operation ± chemotherapy and followed by radiotherapy ± chemotherapy. Both of them showed much better efficacy than chemotherapy (P < 0.001). The Cox multivariate analysis showed that recurrent distant metastases and/or relapse of NPC affected the survival (OR = 2.087, 95% CI = 1.277-3.410, P = 0.003). The T stage of NPC, size of metastatic tumor, hilar and/or mediastinal lymph node metastasis, and the treatment modality were independent prognostic factors.

CONCLUSIONSOperation ± chemotherapy and radiotherapy ± chemotherapy are better treatment of solitary metastatic lung tumor from NPC, which could improve the local control and prolong the PFS and OS. Chemotherapy is recommended for patients with higher T stage of NPC, size of metastatic tumor ≥ 3 cm, pulmonary hilar and/or mediastinal lymph node metastasis.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; secondary ; therapy ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; secondary ; therapy ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pneumonectomy ; methods ; Radiotherapy, High-Energy ; Remission Induction ; Retrospective Studies ; Survival Rate ; Young Adult

This study focused on the intestinal absorption of traditional Chinese medicines (TCM) to reveal the scientific connotation of the compatibility of TCM pairs. The single pass intestinal perfusion (SPIP) was used in rats to compare the absorption of single extracts from Puerariae Lobatae Radix, single extracts from Ginseng Radix et Rhizoma, combined extracts from Puerariae Lobatae Radix and Ginseng Radix et Rhizoma and Puerariae Lobatae Radix and Ginseng Radix et Rhizoma mixture in rats. The content of puerarin, ginsenoside Rg1, ginsenoside Re and ginsenoside Rb1 in liquid were tested by HPLC. The speed constant (Ka) and apparent permeability coefficients (Papp) were calculated and compared. Specifically, the order of puerarin Ka and Papp values from high to low was Ginseng Radix et Rhizoma and Puerariae Lobatae Radix mixture > single extracts from Puerariae Lobatae Radix > combined extracts from Ginseng Radix et Rhizoma and Puerariae Lobatae Radix; the order of ginsenosides Ka and Papp values from high to low was Ginseng Radix et Rhizoma and Puerariae Lobatae Radix mixture > single extracts from Ginseng Radix et Rhizoma > combined extracts from Ginseng Radix et Rhizoma and Puerariae Lobatae Radix. The combined administration of Ginseng Radix et Rhizoma and Puerariae Lobatae Radix may improve the absorption in the intestinal tract.
Animals ; Ginsenosides ; pharmacokinetics ; Intestinal Absorption ; Isoflavones ; pharmacokinetics ; Male ; Medicine, Chinese Traditional ; Panax ; chemistry ; Plant Extracts ; pharmacokinetics ; Pueraria ; chemistry ; Rats ; Rats, Sprague-Dawley ; Rhizome

OBJECTIVETo investigate the effect of chitosan on the capsule inside the expanded flap.

METHODSThe expanders were implanted in animals with the treatment of chitosan(experimental group, n = 15) or without (control group, n = 15). After taking out the expanders, the flap contraction rate was calculated. The samples were observed through HE, Masson dyeing and CD34 immunohistochemical study. The thickness of capsule inside the expanded flap was measured under microscope. The samples were also studied under electron microscope.

RESULTSThe thickness of capsule was 516.000 +/- 128.491 microm in the experimental group, and 833.000 +/- 227.379 microm in the control group (P < 0.05). The number of microvessels was 8.200 +/- 2.150 per visual in experimental group, and 7.900 +/- 1.729 per visual in control group (P > 0.05). Under the electron microscope, the rough endoplasmic reticulum (RER) in the capsule in experimental group decreased and enlarged with degranulation. The mitochondria emerged or disappeared. The number of ribosome was reduced. In the control group, the RER enlarged without degranulation, the mitochondria was intact. The number of ribosome was not reduced.

CONCLUSIONSThe chitosan can effectively reduce the contraction of expanded flap through collagen secretion of fibroblast, delaying the differentiation from fibroblast to fiber cell, inhibiting thansform from fibroblast to myofibroblast. It has no effect on the microvascular generation and expansion, so the flap blood supply will not be affected with thicker capsule.

Animals ; Chitosan ; administration & dosage ; pharmacology ; Female ; Graft Survival ; Male ; Rabbits ; Skin Transplantation ; methods ; Surgical Flaps ; Tissue Expansion

Objective To explore the microanatomic features of the transcallosal-interforniceal approach, and discuss the value of its clinical application. Methods Fifteen adult cadaveric head specimens were dissected by microsurgical anatomic skills to simulate the procedures of the transcallosal-interforniceal approach. Observation and measurement were performed on related anatomic structures. In clinical, 21 patients with the third ventricle tumors underwent tumor resection via the transcallosal-interforniceal approach. Results Using two points on the cortical surface as references that were located 5 and 7 cm anterior to the central sulcus respectively, mean values of related measurements on P5-foramen of Monro (FM) and P7-FM were obtained as follows: (1) the depth of the interhemispheric fissure was 38.46 and 37.62 ram; (2) the height of the corpus callosum was 7.18 and 7.78 nun; (3) the height of the septum pellucidum was 7.53 and 9.88 mm; (4) the thickness of the fornix was 4.72 and 5.16 mm. Under the operative microscope, the tumors were totally removed in 11 cases,subtotally in 8 cases, and partially in 2 cases. Conclusions The corridor of the transcallosal-interforniceal approach should be limited between the lines of P5-FM and P7-FM. The quantitative information obtained in this study permits the preservation of important anatomic structures in operation, such as the motor strip, genu of the corpus callosum, fornical commissure and anterior commissure. This approach is deserved to be applied generally for providing a quite large operative field,making total tumor removal easier, and decreasing the incidence of postoperative complications.

Objective To achieve detailed genomic characterization and investigate the antibiotic-resistant mechanisms of plasmid pA1137 carrying the aminoglycoside resistance gene aacC2.Methods Antibiotic-resistant genes were deter-mined by PCR.Conjugation experiments were performed to verify the transferability of plasmid pA 1137.The minimum in-hibitory concentration(MIC)values of bacterial strains were tested with microdilution method.The genetic background, mobile elements and antibiotic resistance mechanisms of pA 1137 were determined using a whole genome sequencing meth-od.Results Both carbapenem-resistant gene blaIMP-8and aminoglycoside-resistant genes aacC2 and aacA4 were carried by A1137 isolated from Enterobacter cloacae(ECL).aacC2 was located in plasmid pA1137 while the other two resistant genes were observed in chromosomes.Plasmid pA1137 was an IncFⅡplasmid,whose total length was 68.97 kb,and GenBank accession number was MF190369.Plasmid pA1137 contained multiple replicons and intact conjugative transfer regions,so it could be transferred into ECL through conjugation experiments and confer corresponding antibiotic resistance to the transconjugant A1137-EC600.Conclusion IncFⅡ plasmid pA1137 has a single accessory region, the first reported Tn5403-based aacC2-tmrB-related region,which can cause stable inheritance and mediate the resistance to aminoglycoside antibiotics in ECL A1137.

OBJECTIVETo study the regulation of anoikis by tyrosine kinase receptor B (TrkB) in human nasopharyngeal carcinoma lines. METHODS; Expression levels of TrkB and brain-derived neurotrophic factor (BDNF) were evaluated by RT-PCR and Western blot. Colony formation ability of C666-1 was observed in soft agar. Proliferation rate and apoptosis, that change in cells by treating the TrkB inhibitor K252a and specificity ligand BDNF respectively under suspension culture, were measured by cell counting kit-8 (CCK-8) assay and the flow cytometry assay. The expression change of TrkB, BDNF and phosphorylation of serine threonine kinase (p-Akt) were investigated by Western blot analysis.

RESULTSTrkB and BDNF were identified in C666-1 cells. C666-1 cells could be decreased the proliferation of colony in soft agar by effect of K252a, but BDNF could make the colony prolific. K252a can inhibit the expression of TrkB in C666-1, and prevent p-Akt activation. And exogenous BDNF stimulated up-regulation TrkB and p-Akt, induced anoikis resistance.

CONCLUSIONTrkB inhibits anoikis in nasopharyngeal carcinoma cells. Inhibiton of TrkB by K252a can induce anoikis, and may prove particularly effective in treatment of nasopharyngeal carcinoma.

Anoikis ; Carcinoma ; Cell Line, Tumor ; Humans ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; Receptor, trkB ; metabolism