To evaluate the efficacy and safety of pegylated-interferon (Peg-IFN) treatment as monotherapy or in combination with nucleoside analogues (NAs) for treating chronic hepatis B (CHB) infection.Searches of PubMed, OVID, EMBASE, and the Chinese Medical (WanFang, CNKI, and VIP) databases were conducted to identify all relevant randomized controlled trials published since January 1990. Twelve studies comparing Peg-IFN monotherapy to NA combination therapy (lamivudine (LAM), n =8); adefovir (ADV), n = 4) met the inclusion criteria (treatment duration, range: 48-52 weeks; follow-up, range: 24 weeks to three years). Meta-analysis was performed with RevMan 5.0 using the fixed-effects and random-effects models. Patients who had received combination therapy had a higher biochemical response rate at the end of treatment than those who had received monotherapy (51.1% vs. 38.9%, odds ratio (OR) = 1.63, 95% confidence interval (CI): 1.33-2.01, P less than 0.01). Subgroup analysis of Peg-IFN combination therapies with LAM or ADV indicated that neither NA type significantly enhanced the increased efficacy of combination therapy compared to monotherapy. The combination therapy subgroups also had higher virologic response rates at the end of treatment than the monotherapy subgroups (LAM: 65.9% vs. 34.9%, OR = 3.57, 95% CI: 1.83-6.95, P less than 0.01; ADV: 74.6% vs. 46.2%, OR = 3.66, 95% CI: 2.13-6.30, P less than 0.01). Moreover, the combination therapy group had a higher sustained biochemical response rate at the end of follow-up than the monotherapy group (47.6% vs. 42.1%, OR = 1.28, 95% CI: 1.05-1.55, P less than 0.05). The LAM combination therapy subgroup had a significantly higher biochemical response rate than the monotherapy subgroup, but there was no significant difference between the LAM and ADV combination therapy subgroups. At the end of follow-up, the ADV combination therapy subgroup had a significantly lower rate of hepatitis B e antigen (HBeAg) than the monotherapy subgroup, but there was no significant difference between the ADV and LAM combination therapy subgroups for HbeAg reduction. The combination therapy group and monotherapy group showed no statistically significant differences in HBsAg reduction or occurrence of severe adverse events. Peg-IFN/NA combination therapy produces a higher biochemical response rate in CHB patients than PEG-IFN monotherapy. Moreover, Peg-IFN/ADV combination therapy produces a greater reduction in HBeAg than Peg-IFN monotherapy.
Adenine ; administration & dosage ; analogs & derivatives ; Antiviral Agents ; administration & dosage ; adverse effects ; therapeutic use ; Drug Therapy, Combination ; Hepatitis B, Chronic ; drug therapy ; Humans ; Interferons ; administration & dosage ; adverse effects ; therapeutic use ; Lamivudine ; administration & dosage ; Nucleosides ; administration & dosage ; adverse effects ; therapeutic use ; Organophosphonates ; administration & dosage ; Polyethylene Glycols ; administration & dosage ; adverse effects ; therapeutic use ; Randomized Controlled Trials as Topic ; Treatment Outcome

Objective To investigate the effect of lemon peel extracts(LPE) on the activity of lactate dehydrogenase and sucrase of Streptococcus mutans (Sm). Methods After serial dilution with trypticase soy broth (TSB) medium containing 2% glucose, LPE was used as the experimental group, and TSB without LPE as the control group. Sm was added to each group,which was then cultured for 6,18,24 and 48 hours in the anaerobic tank. The activity of lactate dehydrogenase (LDH) was measured with the method of oxidation of reduction coenzyme I and the pH value of the culture solution was also detected. The activity of the sucrose was determined with the method of coloration of 3,5-dinitrosalicylic acid. Results The activity of LDH, sucraae and the changes of solution pH were decreased with the increase of the concentration of LPE (P ＜ 0. 01 ). The activity of LDH were declined from (0. 8025 ± 0. 0913 ) × 103 U/L to (0. 2099 ±0. 0283) × 103 U/L; the activity of sucrase were declined from ( -0. 0107 ±0. 0003) × 103 U/L to ( -0.0078 ±0.0002) × 103 U/L; the△pH were declined from(2.8067 ±0.0404) to (2.5033 ±0. 0416) (24 h results). The differences were significant between experimental groups and the control group (P ＜ 0. 01 ), and there were also significant differences among experimental groups with different LPE concentration( P ＜0. 01 ). The inhibitory effect of acid generation and lactate dehydrogenas' activity of Sm were positively correlated ( P ＜ 0. 01 ). Conclusions LPE can inhibit the activity of lactate dehydrogenase,sucrase and the acid production capacity of the Sm in a dose dependent manner. The inhibitory effects in logarithmic phase is stronger than that in other phases of growth cycle.

Objective： A prospective randomized trial was performed to evaluate the contribution of neoadjuvant chemotherapy in the patients with locoregionally advanced nasopharyngeal carcinoma. Methods： The patients with locoregionally advanced nasopharyngeal carcinoma were treated with either radiotherapy alone (RT group) or neoadjuvant chemotherapy plus radiotherapy (CT/RT group). Neoadjuvant chemotherapy consisting of 2-3 cycles of cisplatin (20 mg/m2 on Day 1 to Day 5), bleomycin (7 mg/m2 on Day 1 and Day 5), and 5-FU (500 mg/m2 on Day 1 to Day 5) followed by radiotherapy was given to CT/RT group. All patients were treated in a uniform definitive-intent radiation therapy in two groups. Results： From 1992 to 1993, 457 patients were enrolled and 440 patients (221 in RT group, 219 in CT/RT group) were assessable. The 5-year overall survival (OS) rates were 62％ for CT/RT group and 55％ for RT group (P=0.1335)； The 5-year relapse free survival rate was 48％ versus 58％ , respectively (P=0.0539). The 5-year free local recurrence (FLR) rate was 82％ for CT/RT group, 74％ for RT group (P=0.0412). There was no significant difference in free distant metastasis (FDM) between two treatment groups (CT/RT group, 79％ ; RT group, 75％ ; P=0.4177). Subgroup analyses showed that neoadjuvant chemotherapy improved local control in patients with T3-4 disease, and had no effect in preventing distant metastases in patients with N2-3 disease. Conclusion： Despite improving FLR and RFS, neoadjuvant chemotherapy and radiatherapy failed to gain other survival benefit or reduce distant metastases in patients with locoregionally advanced nasopharyngeal carcinoma. The indication for neoadjuvant chemotherapy is proposed.

OBJECTIVETo compare the efficacy and safety of a double therapy containing pegylated interferon and ribavirin to a triple therapy (with addition of a protease inhibitor) for untreated chronic hepatitis C with genotype 1 infection.

METHODSWe searched Pub med, EMBASE, OVID, the Cochrane Library Clinical Trials Registry and included relevant randomized controlled trials for comparing the efficacy and safety of the triple therapy to the double therapy in HCV genotype 1 untreated patient, using terms: protease inhibitor, hepatitis C, genotype 1. The primary endpoints were composed of the rates of SVR, the rates of relapse, the rates of anemia, and the rates of discontinuation due to severe adverse events, respectively.

RESULTSFive trials (involving a total of 3200 patients) were included. Data showed the triple therapy with either telaprevir or boceprevir significantly increased the SVR rate and decreased the relapse rate compared with the double therapy [for SVR rate, 65.4% vs. 40.9%, OR=2.92, 95% CI 2.5 to 3.42, P less than 0.01, and for relapse rate, 11.3% vs. 24.8%, OR=0.42, 95% CI 0.26 to 0.68, P less than 0.01], but the triple therapy associated with higher side effects and intolerability [ higher anemia rate, 44.1 % vs. 26.2%, OR=2.25, 95% CI 1.9 to 2.65, P less than 0.01 and higher discontinuation rate owing to severe adverse events, 12.4% vs. 7.7%, OR=1.66, 95% CI 1.19 to 2.32, P less than 0.01]. Subgroup analysis found that the rates of SVR were still higher and the relapse rates were lower in all triple treatment groups [composed by 24 (or 28) -week groups, 48-week groups, and response-guided therapy groups] than that of the double therapy.

CONCLUSIONA triple therapy with peginterferon-ribavirin plus either boceprevir or telaprevir significantly increased the rate of sustained virologic response among untreated patients infected with hepatitis C genotype 1. Both the incidence of adverse events and the frequency of discontinuation owing to severe adverse events were higher in patients receiving the triple therapy than those receiving the standard double therapy.

Antiviral Agents ; adverse effects ; therapeutic use ; Drug Therapy, Combination ; Hepatitis C, Chronic ; drug therapy ; Humans ; Interferon-alpha ; administration & dosage ; adverse effects ; therapeutic use ; Polyethylene Glycols ; administration & dosage ; adverse effects ; therapeutic use ; Protease Inhibitors ; administration & dosage ; adverse effects ; therapeutic use ; Ribavirin ; adverse effects ; therapeutic use ; Treatment Outcome

OBJECTIVETo detect alterations of microsatellite loci [transforming growth factor beta receptor II (TGF-betaRII)(A)(10), TGF-betaRII(GT)(3), hMSH3(A)(8), hMSH6(C)(8), Bax(G)(8), IGFIIR(G)(8), IGFIIR(CT)(3)] and point mutations of TGF-betaRII (TGF-betaRII 452/454, TGF-betaRII 533).

METHODSPCR-SSLP, microdissection-PCR-SSLP, PCR-SSCP, clone sequencing and immunohistochemistry were used.

RESULTSThe mutation rate of TGF-betaRII(A)(10) in RER+ (replication error positive) colorectal carcinomas was 33% (3/9). Similar mutations were also observed in adenomas with severe dysplasia. No mutations at other microsatellite loci were found. RER+ colorectal cancers mainly occurred in male patients at a young age and were more common in the colon than in the rectum (P < 0.05).

CONCLUSIONSRER+ colorectal cancers were found in young males and commonly located in the colon. A one third mutation rate in TGF-betaRII(A)(10) in these patients is lower than that observed in western populations, which may imply diverse pathways of carcinogenesis of RER+ colorectal carcinoma. TGF-betaRII(A)(10) mutation may play a role in the transforming process from an adenoma with severe dysplasia to a full blown carcinoma.

Adult ; Aged ; Colorectal Neoplasms ; genetics ; Female ; Humans ; Male ; Microsatellite Repeats ; Middle Aged ; Point Mutation ; Polymerase Chain Reaction ; Protein-Serine-Threonine Kinases ; Receptors, Transforming Growth Factor beta ; genetics

Based on the full-length cDNA of BmalphaTX14 from Chinese scorpion Buthus martensii Karsch (BmK), gene of the mature peptide of BmalphaTX14 was cloned into the yeast expression vector pPIC9K. After transforming, screening and inducing, tricine-SDS-PAGE and Western blot proved that rBmalphaTX14 protein was expressed in the medium for up to 84 hours, getting nearly 120 mg/L. Recombinant BmalphaTX14 was purified rapidly and efficiently through Ni-NTA-agarose, polyethylene glycol precipitation and gel filtration chromatography. The purified rBmalphaTX14 proved to have the anti-insect activity by toxicity assay. Meanwhile, genomic gene of BmalphaTX14 was cloned and sequenced by PCR method, sequence analysis of this gene showed that BmalphaTX14 had an intron of 408 base pairs located at the signal peptide encoding region, which was similar with the characteristic of other alpha-type sodium ion-channel toxin. Considering both the genomic organization and the peptide function, BmaTX14 proved to be a membership belonging to alpha-type sodium ion-channel toxin.
Amino Acid Sequence ; Animals ; Base Sequence ; Cloning, Molecular ; Molecular Sequence Data ; Pichia ; genetics ; metabolism ; Recombinant Proteins ; biosynthesis ; genetics ; isolation & purification ; Scorpion Venoms ; biosynthesis ; genetics ; Scorpions ; genetics ; Sequence Analysis

OBJECTIVETo evaluate the feasibility and safety of nickel-titanium compression anastomosis ring (CAR27) in colorectal anastomosis after low anterior rectal resection in animal models.

METHODSEnd-to-end colorectal anastomosis was performed using CAR27 in 6 experimental pigs after resection of the middle and lower third of the rectum. The animals were observed postoperatively for up to 56 days. Five pigs were sacrificed at day 14 and the other at day 56. Distance from anal verge to anastomosis and anastomotic circumference were measured. Histopathologic examination was performed.

RESULTSThe median distance from anal verge was 5.3(4-6) cm. No anastomotic leak or other complications were observed. All the pigs recovered and gained weight. In 5 animals sacrificed at day 14, the mean circumference of the anastomosis was 6.8(6.5-7.0) cm, and histopathological examination showed mild inflammatory reaction and fibrosis. In the one sacrificed at day 56, the circumference expanded to 9.3 cm, and no inflammation and fibrosis were observed. Minor adhesion was noticed in only one pig, while smooth and intact serosa in the anastomosis was seen in the rest of the animals.

CONCLUSIONCAR27 is a promising device for mid and low colorectal anastomosis.

Anastomosis, Surgical ; instrumentation ; Animals ; Female ; Male ; Models, Animal ; Nickel ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Swine ; Swine, Miniature ; Titanium

Objective To provide the skin vessels morphologie basis for perforating flap of the antero- lateral thigh(ALT).Methods Six sides lower limbs of adult fresh cadaver specimens perfused with lead oxide-gelatine mixture were used.Observe the peraforators of anterolateral thigh by dissection.The elevated tissue was radiographed by X-ray and MSCT-scanning.Computer techniques was used for the detection and 3D-reconstruction of the regions of each perforators of ALT flap.Results The three-dimensional recostruct- ed digitized visible models perfectly displayed the anatomic structures of arteries on the anterolateral thigh, and,the morphology and distribution of the vascular territory of each perforator from descending branch of LCFA was displayed in the images of 3D-visualization,their effective morphology and distribution were same, and they accord with vascular territory of radiograph.On the 2D-image of X-ray,The margins of the anatomical distribution of each perforator from descending branch of the lateral circumflex femoral artery were determined, their total areas was about 25cm?24cm.Conclusion Since the digitized image of perforator territory can accord with the morphology of anatomy,and can off vascular structure insights into cutaneous perforator anato- my,their 3D visualizative models can be applied in pre-operative designing and virtual operation procedures, and can be helped for study of perforator flap.

BACKGROUNDCentral neurocytoma accounts for 0.1% of primary brain tumor that often occurs in young adults. Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90%. This study aimed to assess the effect of transcortical frontal approach to surgical resection of central neurocytoma on emotion and cognitive function 5 years after surgery.

METHODSTelephone following-up visits were used in this study. By means of neuropsychological testing, assayed emotion, memory and abstract thinking ability of 18 patients undergoing central neurocytoma resection by transcortical frontal approach for 5 years or more, with another 21 normal cases as control group were enrolled. The data were analyzed statistically by paired t test with SPSS11.5.

RESULTSPatients whose central neurocytoma was removed by transcortical frontal approach were not affected on calculating ability 5 years after operation while ability of memory declined sharply (P = 0.000), the older, the more sharply (P = 0.036). Ability of abstract thinking was significantly reduced (P = 0.000), the older, the more significantly as well (P = 0.012); additionally, anxiety and depression occurred in patients rather more than those of control group (P = 0.000), especially cognitive impairment.

CONCLUSIONSTranscortical frontal approach for surgical resection of central neurocytoma has certain long-term influence on patients' life quality, vulnerable to anxiety, depression and cognitive impairment, the severity of which was correlated to age. Therefore, improving surgical approach will be of value for better long-term life quality of patients.

Adolescent ; Adult ; Cognition ; physiology ; Emotions ; physiology ; Female ; Humans ; Male ; Middle Aged ; Neurocytoma ; mortality ; physiopathology ; psychology ; surgery ; Postoperative Period ; Young Adult

OBJECTIVESTo analyze the reliability and clinical value of intraoperative ultrasound combined with neuronavigation for resection of intracranial cavernous malformations.

METHODSFrom January 2007 to December 2009, 40 cases of intracranial cavernous malformations were operated under the application of intraoperative ultrasound combined with neuronavigation. There were 18 male and 22 female, aged 18 to 58 years, with a mean age of 34.5 years. Neuronavigation was used for all patients before operation to display the three-dimensional model of nervous system and lesions, so to design the operative approach and determine the scope of the incision. Lesions were allocated by real-time neuronavigation in order to continuously verify the accuracy of operative approach during the operation, supplemented by real-time monitoring of intraoperative ultrasound to guide the process of surgery and determine the extent of resection of lesions.

RESULTSThe registration error of neuronavigation was 1.3 - 3.2 mm, with an average of 2.0 mm. All the patients' three-dimensional model of nervous system and lesions were satisfactorily displayed, and the area of lesions were all accurately located. Structural brain-shifts occurred in 4 cases in the remove process of the lesion, with shift degree 5.0 - 10.0 mm, and were corrected by intraoperative ultrasound. All lesions were well displayed by intraoperative ultrasound. Gross total resection was achieved in all patients, with no patient infected or dead. Neurological deterioration was seen in 2 patients, the morbidity was 5.0%.

CONCLUSIONSThe combination of neuronavigation and intraoperative ultrasound for resection of intracranial cavernous malformations can provide valuable intraoperative informations of the location and resection level of the lesion, thereby maximize the accuracy of lesion localization and the extent of resection, with less complications and enhanced efficacy of the surgery.

Adolescent ; Adult ; Female ; Hemangioma, Cavernous, Central Nervous System ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Neuronavigation ; Neurosurgery ; methods ; Ultrasonography ; Young Adult