OBJECTIVE: To observe the effect of electroacupuncture (EA) on vascular endothelial growth factor-C (VEGF-C), vascular endothelial growth factor receptor-3 (VEGFR-3), proinflammatory factors and apoptosis in myocardial tissue in mice with acute myocardial ischemia (AMI), and to explore the mechanism of EA for AMI. METHODS: Fifty male C57BL/6 mice were randomly divided into a sham operation group, a model group, an EA group, an inhibitor group and an inhibitor+EA group, 10 mice in each group. Except for the sham operation group, the mice in the remaining groups were intervented with ligation at the left anterior descending (LAD) coronary artery to establish AMI model. The mice in the sham operation group were intervented without ligation after thoracotomy. The mice in the EA group were intervented with EA at "Shenmen" (HT 7) and "Tongli" (HT 5), disperse-dense wave, 2 Hz/15 Hz in frequency, 1 mA in current intensity, 30 min each time, once a day, for 3 d. The mice in the inhibitor group were treated with intraperitoneal injection of SAR 131675 (12.5 mg•kg^-1•d^-1, once a day for 3 d). The mice in the inhibitor+EA group were injected intraperitoneally with SAR 131675 30 min before EA. The ECG before modeling, 30 min after modeling and 3 d after intervention was detected, and the ST segment displacement was recorded; after the intervention, the ELISA method was applied to measure the contents of serum creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST) as well as tumor necrosis factor-α (TNF-α) and interleukin-23 (IL-23) in myocardial tissue; the HE staining method was used to observe the morphological changes of myocardial tissue; the immunofluorescence double labeling method was applied to measure the number of co-expression positive cells of VEGF-C/VEGFR-3 in myocardial tissue; the TUNEL method was used to detect the level of cardiomyocyte apoptosis; the Western blot method was applied to measure the protein expressions of VEGF-C, VEGFR-3, b-lymphoma-2 (Bcl-2), activated caspase-3 (Cleaved Caspase-3) and activated poly adenosine diphosphate ribose polymerase-1 (Cleaved PARP-1). RESULTS: Compared with the sham operation group, in the model group the ST segment displacement was increased (P<0.01); the contents of CK-MB, AST, TNF-α and IL-23 were increased (P<0.01); the arrangement of myocardial fibers was disordered, and interstitial inflammatory cell infiltration was obvious; the number of co-expression positive cells of VEGF-C/VEGFR-3 was decreased (P<0.01); the number of cardiomyocyte apoptosis was increased (P<0.01); the expressions of VEGF-C, VEGFR-3 and Bcl-2 were decreased (P<0.01); the expressions of Cleaved Caspase-3 and Cleaved PARP-1 were increased (P<0.01). Compared with the model group, in the EA group the ST segment displacement was decreased (P<0.01); the contents of CK-MB, AST, TNF-α, IL-23 were decreased (P<0.01); the severity of myocardial pathological injury was reduced; the number of co-expression positive cells of VEGF-C/VEGFR-3 was increased (P<0.01); the number of cardiomyocyte apoptosis was reduced (P<0.01); the expressions of VEGF-C, VEGFR-3 and Bcl-2 were increased (P<0.01); the expressions of Cleaved Caspase-3 and Cleaved PARP-1 were reduced (P<0.01). There was no significant difference in all the indexes between the model group and the inhibitor group (P>0.05). Compared with the model group, the protein expression of VEGF-C was increased in the inhibitor+EA group (P<0.01). Compared with the inhibitor group, in the EA group the ST segment displacement was decreased (P<0.01); the contents of CK-MB, AST, TNF-α, IL-23 were decreased (P<0.01); the severity of myocardial pathological injury was reduced; the number of co-expression positive cells of VEGF-C/VEGFR-3 was increased (P<0.05); the number of cardiomyocyte apoptosis was reduced (P<0.01); the expressions of VEGF-C, VEGFR-3 and Bcl-2 were increased (P<0.01); the expressions of Cleaved Caspase-3 and Cleaved PARP-1 were reduced (P<0.01). Compared with the inhibitor+EA group, all the indexes in the EA group were improved except the protein expression of VEGF-C (P<0.01). CONCLUSION EA could relieve the inflammatory reaction and apoptosis in AMI mice, and its mechanism may be related to activating VEGF-C/VEGFR-3 pathway and promoting lymphangion genesis.
Mice ; Male ; Animals ; Electroacupuncture ; Vascular Endothelial Growth Factor Receptor-3 ; Caspase 3 ; Vascular Endothelial Growth Factor C ; Tumor Necrosis Factor-alpha/genetics* ; Vascular Endothelial Growth Factor A/genetics* ; Poly(ADP-ribose) Polymerase Inhibitors ; Mice, Inbred C57BL ; Myocardial Ischemia/metabolism* ; Apoptosis ; Interleukin-23 ; Proto-Oncogene Proteins c-bcl-2

Objective:To investigate the effects of different mechanical ventilation methods on respiratory function in elderly patients in the steep Trendelenburg position undergoing general anesthesia.Methods:This was a randomized controlled study.Sixty patients scheduled for elective laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia were randomly divided into the lung protective ventilation strategy group(the P group)and the traditional ventilation strategy group(the T group)(n=30, each group). The setting for the P group included FiO 2 at 50%, tidal volume at 6 ml/kg, respiratory rate at 14-16/min, positive end expiratory pressure(PEEP)at 5 cmH 2O, with sustained lung inflation by pressure control every 30 min and the pressure at 30 cmH 2O for 30 s. The setting for the T group included FiO 2 at 50%, tidal volume at 10 ml/kg, and respiratory rate at 10-12/min.Anesthesia was maintained by sevoflurane, remifentanil and cis-atracurium.Driving pressure(DP), mean airway pressure(P mean)and end-tidal carbon dioxide(EtCO 2)were recorded at T1(5 mins after intubation), T2(after pneumoperitoneum), T3(30 mins after pneumoperitoneum), T4(1h after pneumoperitoneum), T5(2h after pneumoperitoneum), T6(3h after pneumoperitoneum)and T7(end of surgery). Arterial blood partial pressure of carbon dioxide(PaCO 2), alveolar-arterial oxygen partial pressure difference[P(A-a)O 2]and oxygenation index(OI)were recorded at T0(entering the operating room), T1, T3, T4, T5, T6, T8(after extubation)and T9(24h after operation). Arterial-end-tidal carbon dioxide partial pressure difference[P(a-et)CO 2]was recorded at T3, T4, T5 and T6. Results:DP in the P group was lower than in the T group at each time point( P<0.01). The P mean in the P group at each time point was higher than in the T group( P<0.01). EtCO 2 was higher in the P group than in the T group at T1( t=0.751, P<0.01)and T2( t=2.830, P<0.01). PaCO 2 was higher in the P group than in the T group at T1( t=1.435, P<0.01), T3( t=2.469, P<0.01)and T4( t=1.359, P<0.05). There were no statistic differences in P(A-a)O 2, OI and P(a-et)CO 2 between the two groups at any time point( P>0.05). Conclusions:Compared with the traditional ventilation strategy, the lung protective ventilation strategy has lower DP and higher P mean during laparoscopic radical prostatectomy, while it has no advantage in lung oxygenation.The lung protection ventilation strategy can be safely used in laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia.

Background: Prospective real-life data on the safety and effectiveness of rituximab in Chinese patients with diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) are limited. This real-world study aimed to evaluate long-term safety and effectiveness outcomes of rituximab plus chemotherapy (R-chemo) as first-line treatment in Chinese patients with DLBCL or FL. Hepatitis B virus (HBV) reactivation management was also investigated. Methods: A prospective, multicenter, single-arm, noninterventional study of previously untreated CD20-positive DLBCL or FL patients receiving first-line R-chemo treatment at 24 centers in China was conducted between January 17, 2011 and October 31, 2016. Enrolled patients underwent safety and effectiveness assessments after the last rituximab dose and were followed up for 3 years. Effectiveness endpoints included progression-free survival (PFS) and overall survival (OS). Safety endpoints were adverse events (AEs), serious AEs, drug-related AEs, and AEs of special interest. We also reported data on the incidence of HBV reactivation. Results: In total, 283 previously untreated CD20-positive DLBCL and 31 FL patients from 24 centers were enrolled. Three-year PFS was 59% (95% confidence interval [CI]: 50-67%) for DLBCL patients and 46% (95% CI: 20-69%) for FL patients. For DLBCL patients, multivariate analyses showed that PFS was not associated with international prognostic index, tumor maximum diameter, HBV infection status, or number of rituximab treatment cycles, and OS was only associated with age >60 years (P < 0.05). R-chemo was well tolerated. The incidence of HBV reactivation in hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative/hepatitis B core antibody-positive patients was 13% (3/24) and 4% (3/69), respectively. Conclusions: R-chemo is effective and safe in real-world clinical practice as first-line treatment for DLBCL and FL in China, and that HBV reactivation during R-chemo is manageable with preventive measures and treatment. Trial Registration ClinicalTrials.gov, NCT01340443; https://clinicaltrials.gov/ct2/show/NCT01340443.
Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; China ; Cyclophosphamide ; administration & dosage ; Doxorubicin ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Lymphoma, Follicular ; drug therapy ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; Male ; Middle Aged ; Prospective Studies ; Rituximab ; therapeutic use ; Vincristine ; administration & dosage

Objective:This article analyzes the cognition and satisfaction evaluation of patients in medical alli-ance. Under the medical alliance mode,the present study tries to explore the choice of medical treatment of patients, the first diagnosis of primary health care institutions and its influencing factors, in order to provide reference for the construction of medical alliance. Methods:With the help of stratified sampling method,eighteen (18) medical alli-ances were selected from 16 districts and counties in Beijing. The survey questionnaire was designed to be used as the tool for data collection. A total of 1 280 patients in medical alliance participated in this study. The Chi-square Test and binary logistic regression model were used for statistical analysis. Results:59.12% of patients understand the medical association and related policies. 39.12% of the patients are satisfied with the medical association,51.44% of patients are willing to take first diagnosis at primary health care institutions. The distribution of medical resources in various districts is uneven. The type of hospital visited,the degree of understanding of medical alliance,the expe-rience of medical alliance and the satisfaction toward medical alliance will have an impact on the willingness about basic initial diagnosis,and the influence make a significant statistical sense. Conclusions:The Medical alliance con-struction in Beijing has achieved a certain effect,as first visit at primary health care institutions will be the initial for-mation. But the unbalanced distribution of medical resources in various districts,the service capacity of primary care institutions which does not meet the needs of patients,the insufficient sensitization of relevant policy and the current health insurance policy are seen as limiting factors to the development of medical alliance.

Objective:In this study,through the description of understanding,behavior,evaluation about med-ical alliances,we explore the problems and made recommendations to medical alliances. Methods: A questionnaire survey was conducted on 556 medical staff in 18 medical alliances in Beijing. We used descriptive statistical methods to analyze the situation of cognition and so on. And we compared medical staff evaluation of medical alliances be-tween core hospital and cooperative hospital. Results: Only 5.40 % of medical staff are totally unaware of the medical alliances policy. 38.73 % of the doctors don't conduct two-way referral. 55.69 % of the doctors in the core hospital don't come to the cooperative hospital. 71.40 % of the medical staff think that the operation of the medical alliances is good. There are big differences in the distribution of overall evaluation between core hospital medical staff and cooperative hospital medical staff by rank sum test. Conclusion: The understanding of medical alliances and the evaluation of activities are better. However, the two-way referral effect is not obvious and some specific activities are not ideal.

Objective Mutated inbred animal model is introduced to the practical course of genetic diagnosis in the hope that medical students are able to apply what they have learned to clinical cases, based on a deep understanding of principle and technology on gene mutation detection. Methods We integrated DNA extraction, polymerase chain reaction, agarose gel electrophoresis, and gel imaging analysis into a comprehensive experiment and arranged 4-year-programme undergraduates majoring in preclinical medical sciences to conduct it with the purpose of investigating the internal relations between phenotype and genotype in a hairless Uncv mouse model. Subsequently, the questionnaire aimed at evaluating learning effect on the part of students was handed out and their feedbacks were analyzed. Results More than 90% of respondents are satisfied with the general learning effect. Especially, 98. 7% of students support the enhancing effect of the new teaching mode on their research skills and 96% consider the practical course helpful to their problem-solving ability. Conclusions The introduction of mutated inbred animal model to the practical system of molecular diagnostics proves beneficial to boost students' learning effect and scientific research quality. Our practice also provokes thoughts on the further utilization of animal models in teaching system of medical sciences.

OBJECTIVETo study the gene expressions in the stromal cells of the human prostate peripheral zone (PZ) in men of different ages.

METHODSWe primarily cultured stromal cells from the normal prostate PZ of men aged 23 -32 (young group) and 56 -75 years (old group), profiled the gene signature of the PZ cells by cDNA microarray, and defined the differential gene expression patterns by hierarchical cluster analysis. Among the differential genes, we selected and confirmed up-regulated genes by quantitative real time PCR (Q-PCR), and identified their protein coding by Western blotting.

RESULTSThere were significant differences in the gene expressions of the PZ cells between the old and young groups. Based on the fold change ratio of > or = 2 or < or = 0.5, 509 up-regulated and 188 down-regulated genes were selected in the PZ cells. A subset of significantly differential genes influencing the growth of adjacent epithelial cells were identified, including HGF, IGF2, IGFBP5 and MMP1 in the old males.

CONCLUSIONStromal cells in the prostate PZ were more active in older males in promoting the malignant progression of adjacent prostate epithelial cells, which might be due to the increased expression of extracellular paracrining mediators.

Adult ; Age Factors ; Aged ; Cell Proliferation ; Cells, Cultured ; Gene Expression ; Gene Expression Profiling ; Humans ; Male ; Middle Aged ; Prostate ; metabolism ; Stromal Cells ; metabolism ; Young Adult

OBJECTIVETo investigate the change of early serum TNF-alpha and IL-6 levels in acute cerebral infarction and its significances.

METHODSSerum TNF-alpha and IL-6 levels in 30 health subjects and 35 patients with acute cerebral infarction (ACI) within 6 hours of onset were measured by enzyme linked immunosorbent assay (ELISA); neurological deficits scores (NDS) in all cases were determined, and Spearman test was used for correlation.

RESULTSThe serum levels of TNF-alpha and IL-6 in ACI group were markedly higher than those in health subjects and there was a positive correlation of TNF-alpha and IL-6 levels with 6 h NDS (rs=0.89 and 0.93, P<0.001) and with NDS progression (rs=0.90 and 0.91, P<0.001). Early serum TNF-alpha and IL-6 levels in progressive cerebral infarction (PCI) group were evidently higher than those in stable cerebral infarction (SCI)[(49.56+/-12.12) pg/L compared with (24.30+/-7.4) ng/L and (39.76+/-7.88) ng/L compared with (20.78+/-6.28) ng/L, respectively, P<0.01)].

CONCLUSIONThe early serum levels of TNF-alpha and IL-6 in ACI markedly increase and are closely correlated with disease severity; which may be of value in PCI risk evaluation.

Acute Disease ; Adult ; Aged ; Biomarkers ; blood ; Cerebral Infarction ; blood ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Time Factors ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo discuss the effectiveness of individualized strategy of surgical management on the great arteries (TGA).

METHODSFrom March 1998 to October 2009, 127 cases (97 males and 30 females) with TGA were treated. There were 97 male and 30 female, aged from 4 hours old to 17 years old with a mean of (25 ± 37) months, weighted from 2.7 to 47.5 kg with a mean of (8 ± 8) kg. The palliative operations included Glenn operation in 14 cases (3 cases double Glenn procedure), Balalock-Taussing shunt in 14 cases, Banding operation in 8 cases, and atrial septal defect enlarge/Banding/Balalock-Taussing shunt in 15 cases. The end-stage operation included Senning procedure in 5 cases, Switch procedure in 32 cases, 2(nd)-stage Switch procedure in 11 cases, Switch procedure with VSD repairing in 20 cases, Switch procedure with Hybrid in 1 case, Nikaidoh procedure in 3 cases, Rastelli procedure in 13 cases, Fonton procedure in 18 cases, other procedure in 4 cases. Twenty-one cases underwent 2 operations, and 5 cases underwent 3 or more operations. Sixty-six cases underwent delayed sternal closure.

RESULTSThere were 12 cases of death operatively in 127 cases. The total operative mortality was 9.4%. There were 5 cases dying of low cardiac output during the operation, 2 of pulmonary hypertension crisis, 2 of hemorrhage, 1 of grafting problem of coronary artery deformation, 1 of renal failure after Fonton procedure and 1 case of newborn dying of spontaneous rupture of liver post-operatively. The patients were followed up for 1 month to 12 years. There were 10 patients with vary degrees complications such as pulmonary stenosis, residual shunt and narrow channel. Three cases underwent reoperation. The rest of survived cases had normal heart function, good growth and development state.

CONCLUSIONSIndividualized strategy of surgical management based on anatomical conditions of TGA can significantly improve the success rate of surgery and long-term survival.

Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Male ; Transposition of Great Vessels ; surgery ; Treatment Outcome

OBJECTIVETo investigate the restoration of erectile function by reconstructing cavernous nerves (CN) with small intestinal submucosa (SIS) grafts.

METHODSWe prepared SIS grafts, established rat models and divided the models into a CN ablation, a sham-operation and an SIS graft group. The CNs at both sides were severed with 1 cm ablated in the first group, and 0.5 cm removed in the third, followed by reconstruction with the SIS grafts. Three months after surgery, the apomorphine test was performed to evaluate the erectile function, and then all the rats were sacrificed to detect the expression of nNOS in the penis.

RESULTSPenile erection was observed in 72.73% (8/11) of the rats for (1.07 +/- 0.89) times within 30 min in the SIS graft group, as compared with 0% (0/11) of the rats for (0.00 +/- 0.00) times in the CN ablation group (P < 0.01), and 90.91% (10/11) of the rats for (2.19 +/- 1.17) times in the sham-operation group (P < 0.01). The number of nNOS nerve fibers was significantly larger in the SIS graft than in the CN ablation group (70.36 +/- 10.09 versus 22.09 +/- 4.76, P < 0.01), but both were significantly smaller than that of the sham-operation group (90.81 +/- 5.69, P < 0.01).

CONCLUSIONThe SIS grafting technique contributes to the recanalization of the severed CN and restoration of erectile function in rats after surgical injury.

Animals ; Erectile Dysfunction ; surgery ; Intestinal Mucosa ; transplantation ; Intestine, Small ; Male ; Nerve Regeneration ; Nerve Tissue ; injuries ; surgery ; Penile Erection ; Penis ; innervation ; Rats ; Rats, Sprague-Dawley