Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis

BACKGROUND

Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and greater probability of having comorbidities. Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression might be less efficacious in patients with a history of childhood trauma than patients without childhood trauma, but findings are inconsistent. Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more unfavourable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma.

METHODS

We did a comprehensive meta-analysis (PROSPERO CRD42020220139). Study selection combined the search of bibliographical databases (PubMed, PsycINFO, and Embase) from Nov 21, 2013, to March 16, 2020, and full-text randomised clinical trials (RCTs) identified from several sources (1966 up to 2016-19) to identify articles in English. RCTs and open trials comparing the efficacy or effectiveness of evidence-based pharmacotherapy, psychotherapy, or combination intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted study characteristics. Group data for effect-size calculations were requested from study authors. The primary outcome was depression severity change from baseline to the end of the acute treatment phase, expressed as standardised effect size (Hedges' g). Meta-analyses were done using random-effects models.

FINDINGS

From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data of a maximum of 6830 participants (age range 18-85 years, male and female individuals and specific ethnicity data unavailable). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, I2=0%), patients with childhood trauma benefitted from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups g=0·016, -0·094 to 0·125, I2=44·3%), with no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, I2=58·0%; no childhood trauma g=0·178, -0·195 to 0·552, I2=67·5%; between-group difference p=0·051), and similar dropout rates (risk ratio 1·063, 0·945 to 1·195, I2=0%). Findings did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; false discovery rate corrected p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but the sensitivity analysis in low-bias studies yielded similar findings to when all studies were included.

INTERPRETATION

Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status.

FUNDING

None.

[In situ semiconductor laser fenestration of type A aortic dissection during thoracic endovascular aortic repair]

Objective: To investigate the feasibility, efficacy and safety of semiconductor laser in situ fenestration of type A aortic dissection during thoracic endovascular aortic repair. Methods: The clinical data of 68 patients with type A aortic dissection treated by semiconductor laser in situ fenestration from June 2016 to January 2020 in Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University were analyzed retrospectively. Of the patients, 45 were male, 23 were female, the mean age was (52±14) years. The technical success rate and complication rates were assessed. Results: The technical success rate of 68 patients was 92.6% (63/68), only 5 patients failed due to the complex aortic arch type, 3 patients underwent chimney stent implantation, 2 patients underwent artificial vessel bypass. During the perioperative period, 1 patient died due to severe pulmonary infection, 4 patients developed neurological symptoms such as cerebral infarction after surgery, and the remaining patients had no related complications. Postoperative CTA follow-up indicated that the primary intercalation rupture was completely closed, and the main and branch stents were patency, 8 (8.8%) type Ⅰ leakage were occurred. Conclusion: It showed that in situ semiconductor laser fenestration is a feasible, effective and safe method to treat type A aortic dissection.

[Significance of prostate central gland/total gland volume ratio combined with PSA in the diagnosis of prostate cancer patients]

Objective: To explore the significance of prostate central gland/total gland volume (PVc/PV) ratio combined with PSA in the diagnosis of PSA 4-20 ng/ml prostate cancer patients. Methods: Data of patients undergoing prostate puncture in Minghang Branch, Zhongshan Hospital from July 2015 to December 2018 were retrospectively analyzed. The anteroposterior, transverse and axial diameters of the prostate and the central prostate gland were measured by magnetic resonance imaging (MRI). The differences of tPSA, f/tPSA, PSAD and PVc/PV between the prostate cancer group and non-prostate cancer group were compared. Receiver operating characteristic (ROC) curves of prostate cancer diagnosis were plotted according to tPSA, f/tPSA, PSAD, PVc/PV alone and PVc/PV combined with tPSA, respectively, and the area under the curve (AUC) was calculated and compared using tPSA as the reference. Results: There was no significant difference in tPSA between the two groups (P>0.05). However, significant differences were observed in f/tPSA, PSAD and PVc/PV between the two groups (P<0.05). The AUC value of PVc/PV combined with tPSA, PVc/PV and PSAD was 0.901 2,0.866 7 and 0.848 1,respectively, which were statistically different from that of tPSA (P<0.05). The AUC value of f/tPSA was 0.716, which was not statistically different from that of tPSA (P>0.05). Conclusion: The PVc/PV ratio combined with tPSA can be used as an important reference index for the diagnosis of prostate cancer in PSA 4-20 ng/ml patients.

Synchronous multiple primary gastrointestinal cancers with CDH1 mutations: A case report

BACKGROUND

Synchronous multiple primary cancers (SMPC) mean two or more malignant tumors occurring simultaneously and with different origins no matter what types they are or where they are located. The carcinogenesis of SMPC often involves variations of some specific genes. However, the correlation between CDH1 mutations and synchronous multiple primary gastrointestinal cancers is largely unknown.

CASE SUMMARY

A 62-year-old woman had sustained abdominal pain for one week and visited our hospital. Gastrointestinal endoscopy revealed multiple small polypoid lesions in both the stomach and colorectum. Computed tomography and laboratory results were within normal limits. Pathological evaluation confirmed signet ring cell carcinoma without obvious metastatic evidence. Malignant cells showed negativity for E-cadherin and positivity for β-catenin in the cytoplasm and nucleus. DNA sequencing performed on paraffin-embedded tissue revealed two exactly coincident alterations in CDH1, C.57T>G and C.1418A>T.

CONCLUSION

This case suggests that the combination of CDH1 mutations and WNT/β-catenin signaling activation contributes to the carcinogenesis of gastrointestinal SMPC.

[The effect of extending proximal landing zone in thoracic endovascular aortic repair on the prognosis of Stanford type B aortic dissection]

With the continuous development of endovascular surgery, thoracic endovascular aortic repair (TEVAR) has gradually replaced traditional open surgery and has become the preferred treatment strategy for Stanford type B aortic dissection. However, the disadvantage of the short proximal landing zone greatly limited the indication of TEVAR surgery and affected the prognosis. In recent years, many strategies such as hybrid surgery, in vitro fenestrated and branched aortic endo-graft, chimney technique, in-situ fenestration technique, etc., have been developed, which greatly broadens the TEVAR indication and improved the prognosis.

[The application of retroperitoneal laparoscopic nephron-sparing surgery in stage T(1b) renal cell carcinoma]

Objective: To investigate the safety and feasibility of retroperitoneal laparoscopic nephron-sparing surgery (NSS) in stage T(1b) renal cell carcinoma (RCC) patients . Methods: Between March 2014 and June 2017, 52 stage T(1b) RCC cases (36 males, 16 females) treated with retroperitoneal laparoscopic NSS in Zhongshan Hospital and Central Hospital of Minhang District were enrolled and retrospectively analyzed, with a tumor size range of 4.0 to 6.8 cm, and a mean size of(4.7±0.45)cm.The anatomic characteristics of tumors, operative time, intra-operative blood loss, warm ischemia time, intra- and post-operative complications, length of hospital stay, and oncological outcomes were reviewed. Results: Only 2 cases converted to open surgery due to uncontrollable bleeding in operation. The rest 50 cases successfully underwent retroperitoneal laparoscopic NSS, with mean operative time of (122±20.86) min (range: 100-220 min), mean blood loss of (140±128.85)ml (range: 50-800 ml), mean warm ischemia time of (30±3.52)min (range: 25-42 min), pre-operative mean serum creatinine of (100±23.54)μmol/L (range: 65-148 μmol/L), mean serum creatinine three monthsafter operation of (104±30.84)μmol/L (range: 72-224 μmol/L), mean drainage of (180±82.33)ml (range: 80-550 ml), mean length of hospital stay after operation of (8±1.56)d (range: 5-15 d). There was no significant difference in renal function between pre- and post-operation (P=0.056). One patient suffered pulmonary embolism was cured conservatively. Fifty patients were followed up, among which 47 cases with malignant pathology were followed up for 3-29 months, and two of them suffered from pulmonary metastasis. Conclusions: After pre-operative comprehensive assessment of tumors, stage T(1b) renal cell carcinoma could be treated with retroperitoneal laparoscopic NSS safely.

A shared effect of paroxetine treatment on gray matter volume in depressive patients with and without childhood maltreatment: A voxel-based morphometry study

AIMS

This study assessed whether antidepressant drug treatment has a common effect on gray matter (GM) volume in MDD patients with and without childhood maltreatment (CM).

METHODS

T1-weighted structural magnetic resonance imaging data were collected from 168 participants, including 51 MDD patients with CM, 31 MDD patients without CM, 48 normal controls with CM, and 38 normal controls without CM. MDD patients received 6 months of treatment with paroxetine, and 24 patients with CM, and 16 patients without CM received a second MRI scan. A whole-brain voxel-based morphometry approach was used to estimate GM volume in each participant at two time points. Two-way analysis of variance (ANOVA) was used to determine the effects of MDD and CM on GM volume at baseline. Repeated measures two-way ANOVA was used to determine the treatment-by-CM interactive effect and main effect of treatment during paroxetine treatment. We further investigated the relationship between GM volume and clinical variables.

RESULTS

At baseline, significant MDD-by-CM interactive effects on GM volume were mainly observed in the left parahippocampal gyrus, left entorhinal cortex, and left cuneus. GM volume was significantly lower mainly in the right middle temporal gyrus in patients with MDD than in normal controls. We did not find any significant treatment-by-CM interactive effects. However, a treatment-related increase in GM was found in the right middle temporal gyrus in both MDD groups.

CONCLUSIONS

These results suggest that paroxetine treatment operates via a shared neurobiological mechanism in MDD patients with and without CM.

Corrosion behaviours of the dental magnetic keeper complexes made by different alloys and methods

The keeper and cast dowel–coping, as a primary component for a magnetic attachment, is easily subjected to corrosion in a wet environment, such as the oral cavity, which contains electrolyte-rich saliva, complex microflora and chewing behaviour and so on. The objective of this in vitro study was to examine the corrosion resistance of a dowel and coping-keeper complex fabricated by finish keeper and three alloys (cobalt–chromium, CoCr; silver–palladium–gold, PdAu; gold–platinum, AuPt) using a laser-welding process and a casting technique. The surface morphology characteristics and microstructures of the samples were examined by means of metallographic microscope and scanning electron microscope (SEM). Energy-dispersive spectroscopy (EDS) with SEM provided elements analysis information for the test samples after 10% oxalic acid solution etching test. Tafel polarization curve recordings demonstrated parameter values indicating corrosion of the samples when subjected to electrochemical testing. This study has suggested that massive oxides are attached to the surface of the CoCr–keeper complex but not to the AuPt–keeper complex. Only the keeper area of cast CoCr–keeper complex displayed obvious intergranular corrosion and changes in the Fe and Co elements. Both cast and laser-welded AuPt–keeper complexes had the highest free corrosion potential, followed by the PdAu–keeper complex. We concluded that although the corrosion resistance of the CoCr–keeper complex was worst, the keeper surface passive film was actually preserved to its maximum extent. The laser-welded CoCr– and PdAu–keeper complexes possessed superior corrosion resistance as compared with their cast specimens, but no significant difference was found between the cast and laser-welded AuPt–keeper complexes. The Fe-poor and Cr-rich band, appearing on the edge of the keeper when casting, has been proven to be a corrosion-prone area.

Antibacterial surfaces based on poly(cationic liquid) brushes: switchability between killing and releasing via anion counterion switching

The development of a smart antibacterial surface that can both kill attached live bacteria and release dead bacteria is reported. The surface consists of counterion-responsive poly(cationic liquid) brushes of poly(1-(2-methacryloyloxyhexyl)-3-methylimidazolium bromide) (PIL(Br)), the properties of which can be switched repeatedly between bacterial killing and bacterial release. Upon counter-anion exchange of PIL(Br) chains using lithium bis(trifluoromethanesulfonyl) amide (LiTf₂N) to yield PIL(Tf₂N), the wettability of the surface changes from hydrophilic (water contact angle ∼52°) to hydrophobic (∼97°). The PIL(Br) chains adopt an extended conformation with bactericidal properties. Counter-anion switching to PIL(Tf₂N) gives a collapsed chain conformation allowing the release of killed bacteria. The switchable killing and releasing actions of the surface were maintained over three cycles. Thus it is concluded that PIL(Br) layers provide a viable approach for the fabrication of "smart" antibacterial surfaces.

Marrying mussel inspired chemistry with photoiniferters: a novel strategy for surface functionalization

We demonstrated a novel strategy of marrying mussel inspired chemistry with photoiniferters for surface functionalization.

Substrate-independent, Schiff base interactions to fabricate lysine-functionalized surfaces with fibrinolytic activity

We demonstrated a simple, substrate-independent approach for the fabrication of lysine-ligand functionalized surfaces with fibrinolytic activity under physiological conditions.

Chlorogenic acid alters the voltage-gated potassium channel currents of trigeminal ganglion neurons

Chlorogenic acid (5-caffeoylquinic acid, CGA) is a phenolic compound that is found ubiquitously in plants, fruits and vegetables and is formed via the esterification of caffeic acid and quinic acid. In addition to its notable biological functions against cardiovascular diseases, type-2 diabetes and inflammatory conditions, CGA was recently hypothesized to be an alternative for the treatment of neurological diseases such as Alzheimer's disease and neuropathic pain disorders. However, its mechanism of action is unclear. Voltage-gated potassium channel (Kv) is a crucial factor in the electro-physiological processes of sensory neurons. Kv has also been identified as a potential therapeutic target for inflammation and neuropathic pain disorders. In this study, we analysed the effects of CGA on the two main subtypes of Kv in trigeminal ganglion neurons, namely, the I_K,A and I_K,V channels. Trigeminal ganglion (TRG) neurons were acutely disassociated from the rat TRG, and two different doses of CGA (0.2 and 1 mmol⋅L⁻¹) were applied to the cells. Whole-cell patch-clamp recordings were performed to observe alterations in the activation and inactivation properties of the I_K,A and I_K,V channels. The results demonstrated that 0.2 mmol⋅L⁻¹ CGA decreased the peak current density of I_K,A. Both 0.2 mmol⋅L⁻¹ and 1 mmol⋅L⁻¹ CGA also caused a significant reduction in the activation and inactivation thresholds of I_K,A and I_K,V. CGA exhibited a strong effect on the activation and inactivation velocities of I_K,A and I_K,V. These findings provide novel evidence explaining the biological effects of CGA, especially regarding its neurological effects.

Titanium-oxo cluster with 9-anthracenecarboxylate antennae: a fluorescent and photocurrent transfer material

Attention has been paid to titanium-oxo clusters (TOCs) modified with functional molecules, because they can be considered as model systems for dye-sensitized titanium oxides in terms of their information in structures and electron transfer. We select 9-anthracenecarboxylate (9-AC) as a photoactive ligand and prepare two model compounds, [Ti6O6(O(i)Pr)6(9-AC)6] (1) and [Ti6O4(O(i)Pr)6(cat)4(9-AC)2] (2) (where cat = catecholate). Structures of the TOCs and the dye-TOC linkage are characterized by single-crystal analysis. Solvent-induced fluorescence change is observed for the cluster solution, and the fluorescence can be turned off by irradiating and on by oxygen bubbling. Photoinduced Ti(III) is responsible for the fluorescence extinction. The photocurrent conversion property of the clusters is examined by use of a three-electrode cell with cluster-coated indium tin oxide (ITO) electrodes. The results indicate that 9-AC is an effective photosensitizer and cluster 1 shows higher photocurrent intensity for its multiantenna structure in comparison with that of 2. Density of states for cluster 1 is calculated, in which the discrete energy bands of Ti6O24 include a number of new energy levels for the contribution of 9-AC molecules.

Effects of moderate static magnetic fields on the voltage-gated sodium and calcium channel currents in trigeminal ganglion neurons

AIM

To study the effects of static magnetic fields (SMF) on the electrophysiological properties of voltage-gated sodium and calcium channels on trigeminal ganglion (TRG) neurons.

METHODS

Acutely dissociated TRG neurons of neonatal SD rats were exposed to 125-mT and 12.5-mT SMF in exposure devices and whole-cell patch-clamp recordings were carried out to observe the changes of voltage-gated sodium channels (VGSC) and calcium channels (VGCC) currents, while laser scanning confocal microscopy was used to detect intracellular free Ca(2+) concentration in TRG neurons, respectively.

RESULTS

(1) No obvious change of current-voltage (I-V) relationship and the peak current densities of VGSC and VGCC currents were found when TRG neurons were exposed to 125-mT and 12.5-mT SMF. However, the activation threshold, inactivation threshold and velocity of the channel currents above were significantly altered by 125-mT and 12.5-mT SMF. (2) The fluctuation of intracellular free Ca(2+) concentration within TRG neurons were slowed by 125-mT and 12.5-mT SMF. When SMF was removed, the Ca(2+) concentration level showed partial recovery in the TRG neurons previously exposed by 125-mT SMF, while there was a full recovery found in 12.5-mT-SMF-exposed neurons.

CONCLUSIONS

Moderate-intensity SMF could affect the electrophysiological characteristics of VGCS and VGCC by altering their activation and inactivation threshold and velocity. The fluctuations of intracellular free Ca(2+) caused by SMF exposure were not permanent in TRG neurons.

[Infect of pingshen decoction on serum HGF, Cys C and TGF-beta1 diabetic nephropathy in early stage]

Study the serum level of HGF, Cys C and TGF-beta1 in type 2 diabetic nephropathy (DN), the infect of Pingshen decoction on those index. Selected 69 cases of 2 type DN and randomly divided into therapy group (36 cases) and control group (33 cases). The therapy group were treated with Pingshen decoction 1 dose/d, bid po. The control group were treated with NephritisShu tablet, 6 tablet, tid po. 8 weeks was a course. Before and after treatment, we examine the serum level of HGF, Cys C and TGF-beta1 by ELISA and immunonephelometry, and compare with 30 cases of healthy control group. The study demonstrates that before treatment, the serum level of HGF in both groups were significantly lower than healthy control group (P < 0.01), but Cys C, TGF-beta1 were significantly higher (P < 0.01). After treatment, the serum level of HGF of both groups were increased. The serum level of HGF of therapy group were significantly higher than of control group (P < 0.01), but the serum level of Cys C and TGF-beta1 were significantly lower than control group (P < 0.01). The serum level of HGF was correlated negatively with Cys C,TGF-beta1. In control group, the UAER, urine beta2-MG and quantity of 24-hour urine protein were significantly decreased after treatment (P < 0.01). The index of urine of therapy group were significantly lower than control group (P < 0.01). Results indicate that test of serum level of HGF and Cys C,TGF-beta1 of diabetic nephropathy have important clinical significance. Pingshen decoction can effectively intervene in the serum level of HGF and Cys C, TGF-beta1 and index of urine.

The phenotype and tissue-specific nature of multipotent cells derived from human mature adipocytes

Dedifferentiated fat (DFAT) cells derived from mature adipocytes have been considered to be a homogeneous group of multipotent cells, which present to be an alternative source of adult stem cells for regenerative medicine. However, many aspects of the cellular nature about DFAT cells remained unclarified. This study aimed to elucidate the basic characteristics of DFAT cells underlying their functions and differentiation potentials. By modified ceiling culture technique, DFAT cells were converted from human mature adipocytes from the human buccal fat pads. Flow cytometry analysis revealed that those derived cells were a homogeneous population of CD13(+) CD29(+) CD105(+) CD44(+) CD31(-) CD34(-) CD309(-) α-SMA(-) cells. DFAT cells in this study demonstrated tissue-specific differentiation properties with strong adipogenic but much weaker osteogenic capacity. Neither did they express endothelial markers under angiogenic induction.

Effect of side-stream phosphorus recovery on biological phosphorus removal performance investigated by chemical and microbial analyses in a novel BNR-IC process

The aim of this study was to assess the effect of side-stream ratio (SSR) on performance of phosphorus (P) removal and recovery in a novel process linking biological nutrients removal (BNR) and induced crystallization (IC). Results showed that P removal efficiency was significantly enhanced when given an appropriate SSR, resulting in effluent P concentrations decreasing from 0.75 to 0.39 mg/L with an increase of SSR from 0 to 35%, where a maximum of 7.19 mg/L P recovery amount was obtained at 35% of SSR. Increasing the SSR can favor the P recovery, while an excessively high SSR (more than 35%) would have a negative effect on the subsequent biological P removal in the BNR-IC system. Polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) analysis showed that in total, 11 DGGE bands of highest species richness were visually detected and significant changes in microbial community structure were found, with SSR variations ranging from 0 to 55%. Moreover, an increase in SSR can cause an increase in microbial community biodiversity; where microbial populations correspond to the 11 bands, they were generally classified into five different phyla or classes (Beta-, Gamma-, and Deltaproteobacteria, as well as Clostridia and Flavobacteria) based on the evolutionary tree analysis.

Effect of Ginkgo leaf extract on vascular endothelial function in patients with early stage diabetic nephropathy

OBJECTIVE

To explore the effect of ginkgo leaf extract (GLE) on vascular endothelial function (VEF) in patients with early stage diabetic nephropathy (DN).

METHODS

Sixty-four patients were randomized equally by a randomzing digital table into two groups, the treated group and the control group. They were all treated for 8 weeks with conventional therapy for diabetes, but GLE tablets were given to the treated group additionally. Changes in VEF were estimated before and after treatment by ultrasonic examination of the brachial artery. In the meantime, changes in plasma levels of the von Willebrand factor (vWF), nitric oxide (NO) and endothelin-1 (ET-1) were observed as well.

RESULTS

The brachial arterial endothelium dependent dilating function in the treated group increased from 4.91+/-2.31% before treatment to 6.78+/-3.89% after treatment (P<0.05), while the level of vWF decreased from 182.05+/-64.13% to 128.56+/-48.98%, and that of NO increased from 50.16+/-24.64 micromol/L to 70.65+/-28.71 micromol/L (P<0.01). However, these indexes were not significantly changed in the control group after treatment (P>0.05).

CONCLUSION

GLE could decrease the plasma level of vWF, raise the plasma NO level and improve the endothelium dependent vascular dilating function in DN patients.

Summary report of action research on occupational rehabilitation and community re-integration of migrant workers with work injuries in Mainland China

This article is a summary of an action research exploring the strategies to initiate the occupational rehabilitation and community re-integration of migrant workers with work injuries in Guangdong Province, China. Using two cases of rehabilitation intervention for workers with work injury, a case management model of occupational rehabilitation and community re-integration was illustrated, in the different phases of rehabilitation. Finally, some key elements in supporting occupational rehabilitation and community re-integration for migrant workers with work injury in China were highlighted.

Meta-analysis of the Clinical Effectiveness of Venous Arterialization for Salvage of Critically Ischaemic Limbs

OBJECTIVE

The aim of this study is to assess the clinical effectiveness of venous arterialization in patients with critical limb ischaemia not reconstructable by conventional bypass.

DESIGN

Meta-analysis of observational studies.

MATERIALS

Eligible studies concerning treatment by venous arterialization for chronic critical leg ischaemia were identified from electronic database, cross-reference search and pertinent articles. There was no language restriction.

METHODS

All relevant studies were systematically reviewed and data extracted by two independent reviewers. Study endpoints were foot preservation, secondary graft patency, postoperative clinical improvement and complications.

RESULTS

A total of 56 studies were selected for comprehensive review. No RCTs were identified. Seven patient series, comprising 228 patients, matched the selection criteria. Overall 1-year foot preservation was 71% (95% CI: 64-77%) and 1-year secondary patency was 46% (95% CI: 39-53%). The large majority of patients in whom major amputation was avoided experienced successful wound healing, disappearance of rest pain and absence of serious complications.

CONCLUSION

On the basis of limited evidence, venous arterialization may be considered as a viable alternative before major amputation is undertaken in patients with 'inoperable' chronic critical leg ischaemia.

[Cloning of human B lymphocyte activation-related novel gene]

OBJECTIVE

To clone the novel activation-related gene of B lymphocyte.

METHODS

The differential display reversal transcription PCR (DDRT-PCR) technique was applied to analyse the expression difference of mRNA between resting and activated B lymphocyte from human tonsil. The positive differential display cDNA fragment identified by Northern-blotting was chosen as probe to filtrate human activated B lymphocyte cDNA library.

RESULTS

Sixty two differential display cDNA fragments (expressed sequence tag, EST) were obtained. Thirty-two of them were mainly expressed in resting B lymphocyte and thirty were expressed in activated cells. Twenty-five were positive ones after identification by Northern blot analysis. A novel cDNA clone was obtained after using EST30 as a probe to filtrate the human activated B cell cDNA library. The whole cDNA clone was 2,048 bp in length and contains a 630 bp open reading frame. The N end of the deduced amino acid sequence was homologous with KAR3 protein which is a member of kinesins superfamily in yeast.

CONCLUSIONS

A novel possible activation-related gene in human B lymphocyte was obtained.

[Effect of beta-endorphin on plasma sialic acid level in rats and the relationship with the immune function]

With the use of beta-EP microinjection into the central nervous system, spectrophotometrical analysis and immunochemical method we studied the effect of beta-Endorphin (beta-EP) on plasma sialic acid (SA) level. The results indicate: (1) The plasma SA level was significantly decreased after microinjection of beta-EP into the lateral ventricle (LV); (2) When beta-EP was microinjection into nucleus arcuatus (ARC), the plasma SA level was significantly decreased (P < 0.05). This effect can be blocked by i.v. atropine or vagotomy; (3) Microinjection of beta-EP into ARC can cause the increase of CD3, CD4 and CD4/CD8, while CD8 was decreased. The above results suggest that the possible mechanism underlying the decrease of plasma SA level is mediated by cholinergic muscarinic receptor, and the cellular immune function is enhanced.