[Safety and efficacy of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis]

Objective: To investigate the efficacy and safety of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis. Methods: A retrospective analysis was carried out on 46 patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis who received endovascular treatment at the Strategic Support Force Medical Center from January 2015 to August 2022. Twenty-seven patients underwent balloon angioplasty alone and 19 patients underwent acute stent implantation. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of the responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality of the two groups were evaluated. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in the acute stenting group was slightly higher than that in the balloon angioplasty group (16/19 vs. 81.5%), but the difference was not statistically significant (P>0.05). Besides, there was no significant difference in the median of mRS between the acute stenting group [3.0(0, 4.0)] and the balloon angioplasty group [4.0(1.0, 5.0)] 90 days after operation (P>0.05). In terms of safety, the incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusions: The effect of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis is not inferior to that of balloon angioplasty, and it does not increase the risk of intracranial bleeding complications.

[Safety and efficacy of intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism undergoing endovascular reperfusion therapy]

Objective: To evaluate the safety and efficacy of intra-arterial tirofiban infusion during endovascular reperfusion therapy in patients with acute cardiogenic cerebral embolism. Methods: Clinical data of 72 patients with acute cardiogenic cerebral embolism caused by large artery occlusion were retrospectively analyzed in Department of Neurology, Strategic Support Force Medical Center from August 2015 to August 2020.Among those, 52 patients were treated with intra-arterial tirofiban, the other 20 patients were treated with control medication. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality were evaluated and compared in two groups. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in tirofiban group was higher than that in control group (92.3% vs. 75.0%), but the difference was not statistically significant (P=0.104). At 90 days after operation, the rate of patients with good prognosis (mRS≤2) in tirofiban group (61.5%) was significantly higher than that in control group (35.0%) (P<0.05). The incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusion: Intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism is effective and feasible, which improves the prognosis without increasing the risk of intracranial bleeding complications.

[Clinical Characteristics and Prognosis Analysis of Pediatric Severe Aplastic Anemia]

OBJECTIVE

To analyze the clinical characteristics and factors affecting prognosis in children with severe aplastic anemia (SAA).

METHODS

Two hundred and five children with SAA treated in our department from January 2008 to April 2018 were selected, and the clinical characteristics and factors affecting prognosis were retrospectively analyzed.

RESULTS

Among 205 SAA children, the effective rate (CR+PR) at 3, 6 and 12 months after immunosuppressive therapy (IST) treatment was 50.9%, 59.0% and 73.9%, respectively, and 5-year overall survival rate was 93.1%±2.0%. Univariate analysis showed that 5-year overall survival rate of SAA children of spontaneous delivery was higher than that of cesarean section (P=0.039), while multivariate analysis showed that birth way had no significant influence on 5-year overall survival rate (P>0.05). The response rate at 3 months after IST of children with a recent history of decoration before SAA onset was higher than those without history of decoration (P<0.05).

CONCLUSION

Most of the SAA children can achieve high response rate and overall survival rate. Patients with recent history of home/school decoration may be the factor affecting hematological response after 3 months of IST, but have no influence on long-term overall survival.

MiR-1207-5p/CX3CR1 axis regulates the progression of osteoarthritis via the modulation of the activity of NF-κB pathway

BACKGROUND

Osteoarthritis (OA) is a prevalent chronic diseases characterized by formation of osteophytes and degradation of articular cartilage. Previous evidence has identified the regulatory effects of microRNAs (miRNAs) in OA. The goal of this study is to clearly explore the biological function of miR-1207-5p in OA.

METHODS

MiR-1207-5p and C-X3-C motif chemokine receptor 1 (CX3CR1) expression in OA cartilages were revealed by accessing to Gene Expression Omnibus database. In vitro OA model was established by lipopolysaccharide (LPS) stimulation. Western blot and quantitative real-time polymerase chain reaction were conducted to detect the expression level of genes. Cell counting kit-8 (CCK-8) and flow cytometric experiments were performed to investigate the proliferation and apoptosis capacities of CHON-001 cells. Bioinformatics analysis was applied to predict the binding site of miR-1207-5p and CX3CR1, the connections of which were ascertained using luciferase reporter assay.

RESULTS

MiR-1207-5p expression was decreased while CX3CR1 was increased in OA cartilages. Up-regulation of miR-1207-5p alleviated the LPS-induced damage in the view of cell proliferation, apoptosis and extracellular matrix (ECM) degradation. A target of miR-1207-5p CX3CR1, its down-regulation intensified the impacts of miR-1207-5p mimic, promoted proliferation and mitigated apoptosis. LPS exposure increased the protein expression of the phosphorylated IκBα and P65, and this phenomena was reversed due to miR-1207-5p up-regulation and CX3CR1 knockdown. The treatment of Betulinic acid (BA; an activator of nuclear factor-κB pathway) reversed the miR-1207-5p mimic-induced inhibitory effect on apoptosis in LPS-treated CHON-001.

CONCLUSION

Our results highlight that miR-1207-5p can prevent CHON-001 from LPS-stimulated injury, providing a novel biomarker for OA progression and further advancing treatment of OA.

[Clinical short-term and long-term efficacy of endoscopic submucosal dissection in the treatment of early low rectal cancer and precancerous lesions]

Objective: To evaluate the short-term and long-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of early low rectal cancer and precancerous lesions. Methods: Inclusion criteria: (1) Distance from the lower margin of tumor to the anal was ≤ 5 cm. (2) Early low rectal cancers were any size rectal epithelial tumors with infiltration depth limited to the mucosa and submucosa, which were diagnosed by postoperative pathology as high-grade intraepithelial neoplasia or adenocarcinoma of the rectum with infiltration depth of intramucosal or submucosal cancer (M or SM stage). (3) Precancerous lesions included adenoma and low-grade intraepithelial neoplasia of the rectum. (4) Patients received ESD treatment. Patients with tumor invasion depth over submucosa by pathology were excluded. From January 2008 to January 2018, 63 patients meeting the above criteria in Peking University First Hospital were enrolled in this descriptive cohort study. The disease characteristics, clinical manifestations, pathological types, treatment time, hospitalization time, en bloc resection rate (resection of the whole lesion), complete resection rate (both the horizontal and vertical incision margins were negative), postoperative complications and follow-up results were analyzed. Cummulative survival rate was calculated by Kaplan-Meier. Results: The diameter of the lesion was (29.0±23.4) mm and the distance from the lesion to the anus was (2.7±1.8) cm. The median operation time was 45.0 (range, 10.0 to 360.0) minutes, the median hospitalization time was 3.0 (range, 2.0 to 12.0) days, en bloc resection rate was 100%, complete resection rate was 96.8% (61/63), and 1 case (1.6%) had postoperative bleeding. The follow-up rate was 87.3% (55/63) and the median follow-up time was 57.9 (range, 15.6 to 121.1) months. No local recurrence was found during the follow-up period and the 5-year survival rate was 100%. Conclusion: Short- and long-term efficacy of ESD are quite good in the treatment of patients with early low rectal cancer and precancerous lesions.

[Microbiome analysis of diabetic foot osteomyelitis by metagenome sequencing technology]

Objective: To analyze the microbiome of diabetic foot osteomyelitis (DFO) by means of metagenome sequencing and provide evidence for identification of pathogenic bacteria in DFO. Methods: A total of 5 patients (3 males and 2 females) with DFO hospitalized at the Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University were enrolled and infected bone specimens were obtained between September 2016 and April 2017. The mean age was (55.8±9.5) years. Metagenome sequencing was performed to explore the characteristics of microbiome, and compared with the results of 16S rRNA sequencing. Results: The results of metagenome sequencing showed that DFO contained diverse microorganism. Totally, 22 dominant species were obtained, Klebsiella pneumoniae (69.66%) was the most abundant, followed by Veillonella parvula (36.93%) and Prevotella intermedia (34.19%). Compared with the 16S rRNA sequencing, metagenome sequencing could obtain more species information on the basis of fewer samples. At the genus level, both sequencing techniques suggested the most dominant pathogen in DFO was anaerobe. All bone specimens had polymicrobial communities. Conclusions: More microecological diversity and abundance of DFO can be found by using metagenome sequencing. At the species level, more bacteria, even bacterial strains can be identified by metagenome sequencing. At the genus level, the most abundant bacteria is anaerobe, however, at the species level, it is facultative anaerobe.

[Clinical features of Wiskott-Aldrich syndrome: an analysis of 13 cases]

OBJECTIVE

To study the clinical features of Wiskott-Aldrich syndrome (WAS) in children.

METHODS

A retrospective analysis was performed for the clinical data of 13 children with WAS.

RESULTS

All 13 children were boys, with a median age of onset of 3 months (range 1-48 months) and a median age of 24 months (range 1-60 months) at the time of diagnosis. Of the 13 children, only 3 had typical WAS and the remaining 10 children had X-linked thrombocytopenia (XLT). The mean WAS score was 2 (range 1-3), the mean platelet count was 20.5×10⁹/L [range (13-46)×10⁹/L], and the mean platelet volume was 8.1 fl (range 6.7-12.1 fl). Lymphocyte subsets and immunoglobulins were measured for 4 children, among whom 1 (25%) had a reduction in both the percentage of CD3⁺T cells per lymphocyte and lymphocyte per nuclear cells, 1(25%) had a reduction in CD3^-CD56⁺ NK cells. Among these 4 children, 1 (25%) had an increase in IgG, 2 (50%) had a reduction in IgM, 1 (25%) had a reduction in IgA, and 4 (100%) had an increase in IgE. A total of 14 gene mutations belonging to 13 types were found in 13 children, among which there were 9 missense mutations (65%), 2 splicing mutations (14%), 2 nonsense mutation (14%), and 1 frameshift mutation (7%). The median follow-up time was 39 months (range 3-62 months), and all 13 children survived.

CONCLUSIONS

Children with WAS often have a young age of onset, and most of them are boys. Major clinical features include thrombocytopenia with a reduction in platelet volume. Missense mutation is the main type of gene mutation.

[Development of Markov models for economics evaluation of strategies on hepatitis B vaccination and population-based antiviral treatment in China]

Objective: To construct the Markov models to reflect the reality of prevention and treatment interventions against hepatitis B virus (HBV) infection, simulate the natural history of HBV infection in different age groups and provide evidence for the economics evaluations of hepatitis B vaccination and population-based antiviral treatment in China. Methods: According to the theory and techniques of Markov chain, the Markov models of Chinese HBV epidemic were developed based on the national data and related literature both at home and abroad, including the settings of Markov model states, allowable transitions and initial and transition probabilities. The model construction, operation and verification were conducted by using software TreeAge Pro 2015. Results: Several types of Markov models were constructed to describe the disease progression of HBV infection in neonatal period, perinatal period or adulthood, the progression of chronic hepatitis B after antiviral therapy, hepatitis B prevention and control in adults, chronic hepatitis B antiviral treatment and the natural progression of chronic hepatitis B in general population. The model for the newborn was fundamental which included ten states, i.e. susceptiblity to HBV, HBsAg clearance, immune tolerance, immune clearance, low replication, HBeAg negative CHB, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma (HCC) and death. The susceptible state to HBV was excluded in the perinatal period model, and the immune tolerance state was excluded in the adulthood model. The model for general population only included two states, survive and death. Among the 5 types of models, there were 9 initial states assigned with initial probabilities, and 27 states for transition probabilities. The results of model verifications showed that the probability curves were basically consistent with the situation of HBV epidemic in China. Conclusion: The Markov models developed can be used in economics evaluation of hepatitis B vaccination and treatment for the elimination of HBV infection in China though the structures and parameters in the model have uncertainty with dynamic natures.

[Cost-effectiveness of community-based treatment of chronic hepatitis B in China]

Objective: Since eliminating hepatitis B in China would need considerable public health resources, the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue. The cost-effectiveness and affordability of the strategy were evaluated in this study. Methods: According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China, the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis. A cohort population aged 20-59 years was used as study subjects. The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention, respectively. The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER) were calculated for the comparison of the strategies. One-way and probability sensitivity analysis were performed for uncertainty of the results. And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies. Results: In the Chinese aged 20-59 years, the ICER of CHB antiviral treatment was 37 598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups, indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population. The ICER of hepatitis B vaccination was -64 000.0 yuan (RMB) per QALYs, indicating that hepatitis B vaccination is cost saving. The CER of CHB antiviral treatment ranged from 731.8 to 1 813.3 yuan (RMB) per QALYs compared with hepatitis B vaccination, and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups, indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment. The price of antiviral drug, entercavir, can influence the cost effectiveness of CHB antiviral treatment. If the price of entercavir declined half, CHB antiviral treatment would be cost-saving. The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored, although the results of economics evaluation of CHB antiviral treatment were reliable. The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB), the probability of implementing the strategy was 42.6% if the budget reaches 127 million yuan (RMB), and only when the budget reaches 269 million yuan (RMB), the goal of CHB antiviral treatment strategy can be fully realized. Conclusions: Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective, it is not an appropriate public health measure due to the high cost. The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.

[Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China]

Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined, the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state. Only when the annual budget reaches 688.8 million yuan (RMB), the goal of PMTCT would be fully realized. Conclusions: The PMTCT strategy in China was cost effective, and the cost is not beyond the financial budget needed and the willing to pay. The strategy, which is consistent with the global hepatitis B elimination efforts, should be conducted widely in China.

[Advances in the treatment of juvenile myelomonocytic leukemia]

Juvenile myelomonocytic leukemia (JMML) is a rare chronic myeloid leukemia in children and has the features of both myelodysplastic syndrome and myeloproliferative neoplasm. It is highly malignant and has a poor treatment outcome. Children with JMML have a poor response to conventional chemotherapy. At present, hematopoietic stem cell transplantation is the only possible cure for this disease. In recent years, significant progress has been made in targeted therapy for mutant genes in the Ras signaling pathway and demethylation treatment of aberrant methylation of polygenic CpG islands. This article reviews the treatment and efficacy evaluation of JMML.

[Cost-effectiveness and cost-benefit analysis on strategy for preventing mother-to-child transmission of hepatitis B virus]

OBJECTIVE

Through cost-benefit analysis (CBA), cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus.

METHODS

Based on the principle of Hepatitis B immunization decision analytic-Markov model, strategies on PMTCT and universal vaccination were compared. Related parameters of Shenzhen were introduced to the model, a birth cohort was set up as the study population in 2013. The net present value (NPV), benefit-cost ratio (BCR), incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared.

RESULTS

A decision tree was built as the decision analysis model for hepatitis B immunization. Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program. The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013, with BCR as 14.37. The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person, with BCR as 12.07. Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit. When comparing with the universal vaccination program, the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person. The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program. In the CBA and CEA hepatitis B immunization programs, the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors. Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective.

CONCLUSIONS

The PMTCT strategy gained more economic benefit and effects on health. However, the cost of PMTCT strategy was more than the universal vaccination program, thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program. CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation. Hopefully, programs as combination of the above said two methods would facilitate the process of economic evaluation.

[Recombinant human tumor necrosis factor receptor type Ⅱ-IgG Fc fusion protein for treatment of occupational medicamentosa-like dermatitis induced by trichloroethylene]

Objective: To investigate the efficacy and safety of the recombinant human tumor necrosis factor receptor Ⅱ-IgG Fc fusion protein (rhTNFR: Fc, etanercept) for the treatment of occupational medicamentosa-like dermatitis induced by trichloroethylene (OMLDT) . Methods: In September 2011 to February 2016, 12 patients with OMLDT were treated with etanercept 25 mg, subcutaneous injection, twice per week, doubling of first dose. The course of treatment was 6 weeks. The drug eruption area and severity index (DASI) score, the proportion of patients achieving a 50%, 75% and 90% reduction in DASI (DASI50, DASI75, DASI90) and the serum level of TNF-α were used to assess the efficacy at different times. Adverse reactions were also recorded and evaluated. The results were statistically analyzed by nonparametric Friedman test and repetitive measurement ANOVA using the software SPSS19.0. Results: After 4 weeks treatment, the DASI score decreased form 56.33±7.02 to 0.50±0.91 (P<0.01) . The DASI50, DASI75 and DASI90 were all increased to 12 (100%) . The serum level of TNF-α decreased form (43.74±41.62) pg/ml to (3.03±0.47) pg/ml (P<0.01) . Statistically significant difference was observed from the above indexes. There were no adverse reactions in clinical application. Conclusion: Recombinant human tumor necrosis factor receptor Ⅱ-IgG Fc fusion protein may be a safe and effective drug in the treatment of OMLDT.

[Effects of prenatal maternal seizure on hippocampal damage and cognitive deficits in offspring rats]

Objective: To observe hippocampal damage and cognitive impairment of offspring exposed to prenatal maternal seizure induced by amygdala kindling, and to explore the underlying mechanism by the detection of pathological changes of placenta. Method: Adult female SD rats were randomly divided into three groups: control group(8 rats), kindling group(12 rats) and sham group(8 rats). All the rats were allowed to mate after one week's fully kindling. The pregnant rats in kindling group received electric stimulation every 48 h. Dams were allowed to deliver naturally. Effects of maternal seizure on the number of offspring, the survival rate and body weight of pups were observed. HE staining was used to visualize histopathological changes of placenta. Morris water maze test was used to assess the cognitive function and Nissal's staining to detect hippocampal morphology of the offspring. One-way ANOVA analysis and χ² test were used. Result: Compared with the sham group (95%(78/82)) and the control group (95%(82/86)), the survival rate of pups in kindling group(81%(66/82))was much lower (χ²=13.817, P=0.001). There were no significant differences in the number of pups per litter and pups birth-weight between kindling group and sham group or control group(F=0.312 and 0.257, P=0.736 and 0.776). HE staining showed that placental tissues from control and sham groups were normal whereas the histologic abnormalities of placentas from kindling group were characterized by thickening of the villus vascular walls, luminal stenosis, trophoblasts hyperplasia, abnormalities of trophoblasts with nuclear pyknosis and karyorrhexis and accumulation of inflammatory lymphocytes in labyrinthine zone. Nissl staining showed that neurons in hippocampus of P₀(0 d after birth) and P₈₄(84 d after birth) offspring from control and sham groups were normal, but neuronal damages were obvious in hippocampus of P₀ and P₈₄ offspring from kindling groups, and the damages in P₀ pups were severe with a marked loss of neuron, shrinkage of cells and nuclear pyknosis and karyorrhexis. In the Morris water maze, compared with the sham group ((29±8), (19±9), (10±4)s) and the control group ((25±6), (17±5), (14±4)s) rats in the kindling group ((36±8), (29±8), (30±11)s) exhibited significantly longer escape latency from the 3^rd, 4^th, and 5^th days (F=6.276, 7.518, 18.422, P=0.030, 0.003, 0.000), significant less time in the target quadrant ((27±8) vs.(58±11)and(68±13)s, F=35.993, P=0.000) and reduced number of crossing the platform ((4.4±1.7) vs. (7.2±1.6) and (8.5±1.3)times, F=18.377, P=0.000). In addition, there was no significant difference between control and sham groups(P all >0.05). Conclusion: The prenatal maternal seizures induced significant pathological damages to hippocampus and cognitive impairment of offspring. Hypoxia-ischemia of placenta might play an important role in this process.

Clinical value of detection of anti-Helicobacter pylori antibody in urine

Helicobacter pylori (H. pylori) is a kind of gram-negative anaerobic bacterium that was first successfully isolated and cultivated from the specimens of the gastric mucosa by Warren and Marshall in 1983. It is one of the risk factors for gastric cancer and is closely related with chronic gastritis, peptic ulcer, gastric cancer and other diseases of the digestive system. There are a variety of detection technologies and diagnostic methods available for H. pylori infection, including direct detection of the bacterium, urease detection, antigen and antibody detection, polymerase chain reaction and so on. Generally, these methods can be divided into two major categories: invasive and non-invasive. However, no single test can be considered the gold standard for the diagnosis of H. pylori infection. In this paper, we will summarize a kind of completely non-invasive detection method - detection of H. pylori antibody in urine, review its use in the diagnosis of ongoing infection, and discuss its value in clinical applications.

Environmental exposure and risk of uterine leiomyoma: an epidemiologic survey

AIM

The present study was undertaken to explore the relationship between environmental exposure and risk of uterine leiomyoma in women using an epidemiologic survey.

SUBJECTS AND METHODS

We conducted a case-control survey of premenopausal Han women aged 30-50 years in Nanjing. The subjects included 600 patients with uterine leiomyoma confirmed at the Affiliated Zhongda Hospital of Southeast University between February 2010 and June 2012 and 600 patients with non-uterine leiomyoma or healthy volunteers who presented to the above mentioned hospital for physical examination during the same period. We entered the results into a database and explored the relationship between risk factors and prevalence of uterine leiomyoma using univariate or multivariate non-conditional logistic regression analysis.

RESULTS

The results showed that patients aged 40-45 years had a high prevalence of uterine leiomyoma. The prevalence of uterine leiomyoma in subjects with an education beyond high school was higher than in those with a high school education or less. Exposure to plastic products (odds ratio [OR]: 1.481; 95% confidence interval [CI]: 1.046-2.097); exposure to cosmetics and other chemicals (OR: 1.954; 95% CI: 1.479-2.582); and consumption of soybean milk (OR: 2.518; 95% CI: 1.894-3.347), food additives, sweeteners, and preserved food (OR: 3.166, 95% CI: 2.247-4.461) had a significant effect on the occurrence of uterine leiomyoma (p < 0.05).

CONCLUSIONS

Exposure to plastic products, cosmetics, and other chemicals as well as intake of soybean milk, food additives, sweetener, and preserved foods may be risk factors for uterine leiomyoma.

Octreotide is the favorable alternative for cisplatin resistance reversal of ovarian cancer in vitro and in nude mice in vivo

This study aimed to observe the effects of octreotide (OCT) on cisplatin resistance reversal of cancer cells in vitro and in nude mice in vivo. MTT method and flow cytometry were used to investigate the effect of cisplatin, OCT or the combination of these two compounds on the proliferation and apoptosis of SKOV3-DDP cells. The size and weight of xenograft tumors from the nude mice model were measured. Real-time PCR was used to detect the mRNA expression of SSTR2, MDR1, MRP2, GST-pi and EGFR in SKOV3/DDP cells following the different treatment. At the concentration of 2.5-20 g/ml, OCT significantly reduced IC50 (p < 0.05) and promoted apoptosis (p < 0.05) of SKOV3-DDP cells' response to cisplatin. Unchanged expression was found in SSTR2 on the SKOV3/DDP cell in vitro after OCT treatment, but increased expression in vivo (p < 0.05). OCT increased GST-pi expression (p < 0.05) and reduced MRP2 and EGFR expression (p < 0.05) in a dose-dependent manner. The similar results were obtained in mice in vivo experiment, except the reduced expression of GST-pi. It is suggested that OCT could inhibit ovarian cancer proliferation and promote apoptosis, via the cell surface SSTR2, and reverse cisplatin resistance through inhibition of MRP2, EGFR, and even GST-pi expressions.

Ent-16β,17-dihydroxy-kauran-19-oic acid, a kaurane diterpene acid from Siegesbeckia pubescens, presents antiplatelet and antithrombotic effects in rats

The antiplatelet and antithrombotic effects of ent-16β,17-dihydroxy-kauran-19-oic acid (DDKA) isolated from Siegesbeckia pubescens were investigated with different methods both in vitro and in vivo. We tested the antithrombotic activity of DDKA in arterio-venous shunt model. The effects of DDKA on adenosine diphosphate (ADP)-, Thrombin-, Arachidonic acid-induced rat platelets aggregation were tested in vitro. We also assessed its bleeding side effect by measuring coagulation parameters after intravenous administration for 5 days and investigated the potential mechanisms underlying such activities. In vivo, DDKA significantly reduced thrombus weight in the model of arterio-venous shunt. Meanwhile, DDKA increased plasma cAMP level determined by radioimmunoassay in the same model. Notably, DDKA prolonged PT and APTT in rats after intravenous administration DDKA for successive 5 days. In vitro, pretreatment with DDKA on washed rat platelets significantly inhibited various agonists stimulated platelet aggregation and caused an increase in cAMP level in platelets activated by ADP. These findings support our hypothesis that DDKA possesses antiplatelet and antithrombotic activities. The mechanisms underlying such activities may involve the anticoagulatory effect and cAMP induction.

In vitro and in vivo antitumor activity of Macrothelypteris torresiana and its acute/subacute oral toxicity

The aim of this study was to evaluate the antitumor potential of Macrothelypteris torresiana by studying in vitro antitumor activity of the protoapigenone, as well as in vivo antitumor activity and acute/subacute oral toxicity of the total flavonoid fraction from the roots of M. torresiana. Considering that the protoapigenone is a main constituent of the total flavonoid fraction and it might play a key role in the antitumor activity of M. torresiana, the MTT assay was used to investigate the in vitro antitumor activity of the protoapigenone. Our study revealed that the protoapigenone of M. torresiana showed significant antitumor activity towards Hep G2, Tca-8113, MCF-7, M5 and K562 with IC(50) values of 2.3, 0.6, 0.8, 0.3 and 0.9 μg/ml, respectively. The antitumor potential of the total flavonoid fraction was evaluated using preparations 1, 2 and 3, which were prepared by total flavonoid fraction directly diluted with sterile saline, dissolved using sodium carboxymethyl cellulose (CMC-Na) and included by hydroxypropyl-β-cyclodextrin, respectively. These were investigated in vivo using mouse sarcoma S-180 in BALB/c mice after completing tumor inoculation for 24h. Pronounced antitumor activity was observed in the treated groups for preparations 2 and 3, and the high and medium doses in particular showed very high inhibition ratio of tumor growth (>50%). No significant difference was observed when compared to the positive control group (5-fluorouracil). The acute/subacute oral toxicity test was performed, and the results of acute oral toxicity showed that the LD(50) values of preparations 2 and 3 were 2.76 and 0.87 g/kg body wt., respectively. According to the results of the subacute oral toxicity study, the total flavonoid fraction had low toxicity. The overall results of this study suggest that the total flavonoid fraction from the roots of M. torresiana shows significant antitumor activity and represents a potential source of medicine for the treatment of cancer.

Osteoblastic cell response on fluoridated hydroxyapatite coatings: the effect of magnesium incorporation

Magnesium (Mg) ions were incorporated into fluoridated hydroxyapatite (HA) coating by the sol-gel dip-coating method. Mg in the coating was measured by x-ray photoelectron spectroscopy (XPS). The changes of calcium and magnesium concentrations were recorded to monitor the dissolution behavior of the coatings. In vitro cell responses were evaluated using MG63 cells in terms of cell morphology, proliferation and differentiation. The substitution of Mg and F ions into the HA crystal structure was confirmed by XPS. Only a limited amount of Mg can be incorporated into HA lattice. The dissolution test revealed that Mg incorporation increased the solubility of the coating in the tris-buffered saline solution. The highest solubility was achieved at x = 1.5 (Ca((10-x))Mg(x)(PO(4))(6) F(OH). In the cell culture test, well-spread cells were observed on all the coatings. Also, a significantly positive effect of Mg ions on cell proliferation and late differentiation was found at x = 1.5. Mg incorporation stimulates osteoblastic cell responses on fluoridated hydroxyapatite coatings.

Huperzine-A in capsules and tablets for treating patients with Alzheimer disease

AIM

To compare the efficacy and safety between huperzine-A (Hup) in capsules and tablets for treating patients with Alzheimer disease (AD).

METHODS

Using multicenter, prospective, double-blind, double-mimic, parallel, positive controlled and randomized methods, 60 patients meeting with the NINCDS-ARDRA criteria of AD were divided into 2 equal groups. Patients in the capsule group received 4 capsules of Hup (each contains 50 micrograms) and 4 tablets of placebo (lactose and starch inside); while the tablet group received 4 tablets of Hup (each contains 50 micrograms) and 4 capsules of placebo, p.o., twice a day for 60 d. All the patients were evaluated with a lot of related ranting scales, and physiological and laboratory examination.

RESULTS

There were significant differences (P < 0.01) on all the psychological evaluations between 'before' and 'after' the 60-d trial of 2 groups, but there was no significant difference between 2 groups by group t test (P > 0.05). The changes of oxygen free radicals in 2 groups showed marked improvement. No severe side effect besides moderate to mild nausea was found in both groups.

CONCLUSION

There is equal efficacy and safety between Hup in capsule and tablet for treating patients with AD, and Hup can reduce the pathological changes of the oxygen free radicals in the plasma and erythrocytes of patients with AD.

[Contrast analysis of brainstem auditory evoked potential in untreated and treated hepatolenticular degeneration patients with treatment of combining traditional Chinese and Western medicine]

OBJECTIVE

To observe the effect of combination therapy of traditional and Western medicine (TCM-WM) on brainstem auditory evoked potential (BAEP) in hepatolenticular degeneration patients.

METHODS

BAEP was recorded and analyzed in 65 patients with hepatolenticular degeneration (HLD) before and after decoppered TCM-WM treatment.

RESULTS

The peak latency (PL) and interpeak latency (IPL) of BAEP in untreated patients were greatly increased compared with those of control group, especially in the prolongations of III, V, III- V and I-V. The PL and IPL improved as improvement of clinical symptoms in HLD patients treated with TCM-WM than that in untreated patients. The abnormal rates of men and women in BAEP were decreased from 21.97% and 19.05% in untreated patients to 9.09% and 6.75% in treated patients respectively.

CONCLUSION

BAEP not only has an complementary diagnosis but also judge the efficacy of treatment on the HLD disease.

[Prospective study on intelligence quotient of 28 hepatic lenticular degeneration patients with treatment combining traditional Chinese and Western medicine]

Intelligence quotient (IQ) of 28 hepatic lenticular degeneration (HLD) patients was analysed with Wechsler Adult Intelligence Scale-revised by China (WAIS-RC) before and after two months treatment by the HLD-Relief decoction supplemented with copper-clearing drug, and the result was compared with that of 30 healthy persons for control. The results showed that the Vocable IQ (VIQ), Performance IQ(PIQ) and Full IQ(FIQ) of HLD patients were markedly lower than that of control (P < 0.005), especially in visual space disorder, which indicated that the copper ion depositing in patient's brain not only damaged neuronic motorial functions but also produced a marked effect on the patient's intelligence. After treatment, the total intelligential level including VIQ, PIQ and FIQ has been raised, particularly in PIQ in which all scores were obviously increased (P < 0.001). It was also showed that the damage of intelligence in HLD patient became more serious as the course of disease was prolonged and the early treatment facilitated the IQ level to approach the normal criterion. It indicated that the treatment with combined therapy is effective to the intelligence and extrapyramidal symptoms in HLD patients.

Morphology-based interpolation for 3D medical image reconstruction

Interpolation is an important processing step in 3D reconstruction. A new method, based on mathematical morphology, is presented here to implement the interpolation by means of a combined operation of weighted dilation and erosion. Compared with previously proposed methods, the new approach successfully resolves the interpolation problem when there is no overlapping area between the two objects. In the mean time, it has a wide adaptability and is easy to implement.

[Clinical analysis of 40 cases of malignant tumor of the floor of the mouth]

This is a retrospective review for 40 patients with malignant tumour of the floor of mouth.In the group,squamous carinoma is 62.5%.adenoid cystic carcinoma is 22.5%.Both of them are the major type,stage III.IV were 72.5%,Generally ipsilateral;radical mandibular and neck dissection was performed sellectively.65% of patient were given preoprative chemotherapy.Total 5 years survival rate was 50%,for stage I-III were 78.6%.Although preoperative chemotherapy was given that the group of lower pathological differetiation was still in lower survival rate,higher recurrence and mortality than those given surgery alone. Survival rate for squamous carcinoma was higher than that for adenoid cystic carcinoma.

[Acute side effect of postoperative radiotherapy in malignant head and neck neoplasm]

From August 1989 to May 1991,160 patients with malignancies of the head and neck region were treated by surgery and postoperative radiotherapy.Seventy seven patiens underwent resection of the primary lesion combined with neck dissection and 83 patients had resecton of the primary lesion only before radiotherapy.After irradiation 33.8% (54/160) patients developed edema in face and neck,13.1%(21/160) patients developed headache.The style of neck dissection (unilateral,bilateral or no neck dessection) did significantly influence the rates of the acute side effect(P<0.01).The interval between surgery and radiotherapy and radiation dose were not important influential factors(P>0.05).The clinical manifestations,possible mechanism and prevention of the acuter side effect is presented.

[Anti-arrhythmic effects of matrine]

Matrine (MT) is an alkaloid isolated from Sophra alopecuroids L. The LD50 of MT iv to mice was 72.1 mg/kg (95% CL 68.2-76.5 mg/kg). MT had significant effects on different experimental models of arrhythmias induced by aconitine, barium chloride or coronary ligation. The ECG of anesthetized rats was significantly changed after iv of MT. The HR was retarded and the PR and QTc intervals were prolonged.