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    Translational medicine
    2016, 36 (03):  308. 
    Abstract ( 314 )   PDF (1708KB) ( 984 )  
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    Pursuit of excellence with soul
    2016, 36 (03):  311. 
    Abstract ( 470 )   PDF (1604KB) ( 859 )  
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    Original article (Basic research)
    Effects of singlestranded DNA binding protein 2 on trophoblastic differentiation in mouse embryonic stem cells
    LIU Jifeng, LI Hui
    2016, 36 (03):  313. 
    doi: 10.3969/j.issn.16748115.2016.03.001

    Abstract ( 653 )   PDF (4630KB) ( 992 )  

    Objective To identify novel genes promoting trophoblastic differentiation in mouse embryonic stem (ES) cells. Methods Inducing conditions for trophoblastic differentiation in mouse ES cells were optimized. Combined with data analysis, significantly upregulated genes during this differentiation process were identified and singlestrandedDNA binding protein 2 (Ssbp2) was discovered as a candidate gene involved in trophoblastic differentiation. Changes in Ssbp2 expression during the process of trophoblastic differentiation in mouse ES cells, as well as expression patterns of Ssbp2 in three cell types corresponding to early mouse embryos, were detected by qRT-PCR. Then Ssbp2 genes were cloned and overexpressed in mouse ES cells. Cell morphology was observed and whether Ssbp2 genes could promote trophoblastic differentiation in mouse ES cells was detected. Results Through trials with different combinations, we found serumfree mouse TS cell basic medium with BMP4 and bFGF could not only induce significant upregulation of trophoblast markers in mouse ES cells, but also efficiently repress the up-regulation of mesoderm markers. Expression pattern analysis showed that the expression level of Ssbp2 was significantly up-regulated during the process of inducing trophoblastic differentiation in mouse ES cells and Ssbp2 expression was high in mouse trophoblastic TS cells. After overexpression of Ssbp2 in mouse ES cells, ES cells were partially differentiated and the up-regulation in trophoblastic markers was most significant. Conclusion Ssbp2 can promote trophoblastic differentiation in mouse ES cells.

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    Regulation of aquaporin 1 expression in rat pulmonary microvascular endothelial cells by free fatty acid mixture and action mechanism
    ZHANG Yi-wei, TIAN Kun, WANG Yan, et al
    2016, 36 (03):  322. 
    doi: 10.3969/j.issn.16748115.2016.03.002

    Abstract ( 654 )   PDF (1589KB) ( 868 )  

    Objective To investigate the regulation of aquaporin 1 (AQP1) expression in rat pulmonary microvascular endothelial cells (PMVECs) by free fatty acid (FFA) mixture and action mechanism. Methods Western blotting was used to detect changes in AQP1 protein expression in rat PMVECs after FFA treatment for different periods. Western blotting and real-time PCR were used to detect changes in AQP1 protein and mRNA expressions in rat PMVECs after being treated with FFA at different concentrations. The effect of FFA treatment on AQP1 expression was detected by Western blotting after p38 MAPK pathway had been suppressed by SB203580. Results AQP1 protein expressions in RAT PMVECs after being treated with FFA for 6 and 12 h were significantly higher than those in the blank control group (P=0.000,P=0.003). AQP1 protein expressions in 200 μmol/L and 500μmol/L FFA groups were significantly higher than those in the blank control group (P=0.007, P=0.002). AQP1 mRNA expressions in 100 μmol/L, 200 μmol/L and 500μmol/L FFA groups were significantly higher than those in the blank control group (P=0.000). SB203580 pretreatment could suppress FFA-induced increase in AQP1 protein expression in rat PMVECs (P=0.016). Conclusion FFA can up-regulate AQP1 expression and affect AQP1-mediated intrapulmonary water transport progress in fat embolisms to a certain extent. The regulation mechanism may be associated with activation of p38 MAPK signaling pathway.

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    Role of endoplasmic reticulum stress in hyperglycemiacaused microvascular injury
    Wang Heng, Wang Hong-ying, Li Ji-bin, et al
    2016, 36 (03):  328. 
    doi: 10.3969/j.issn.16748115.2016.03.003

    Abstract ( 587 )   PDF (1594KB) ( 697 )  

    Objective To investigate the role of endoplasmic reticulum (ER) stress in microvascular injury in hyperglycemic SD rats. Methods Healthy male SD rats were intraperitoneally injected with streptozotocin (STZ) to construct a hyperglycemic rat model. Blood pressure (BP) was measured by noninvasive caudal artery blood pressure measurement one month after the model was constructed, and body weight and random blood glucose level were monitored. Gene transcriptional levels of ER stress-related factors in rat mesenteric resistant arteries (MRAs) were measured by RT-PCR. Protein levels of GRP78/Bip, eNOS, Akt and IRS1 were detected by Western blotting. Results Random blood glucose level, systolic BP, diastolic BP and mean arterial pressure in the hyperglycemic group were significantly higher compared with the control group. RT-PCR showed that mRNA levels of ER stress main markers in rat microvascular tissue in the hyperglycemic group significantly increased (P<0.05). Western blotting showed that Bip protein level in the hyperglycemic group significantly increased (P<0.05) and phosphorylation of IRS1, Akt and eNOS significantly decreased (P<0.05). Conclusion Persistent hyperglycemia can induce hypertension in rats, which may be associated with ER stress-mediated microvessel dysfunction, impaired insulin signaling pathway in vascular tissue and decrease in eNOS activity.

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    Knock out FLO8 gene in Candida albicans by fusion PCR combined with homologous recombination
    LI Wen-jing, LIU Jin-yan, SHI Ce, et al
    2016, 36 (03):  334. 
    doi: 10.3969/j.issn.16748115.2016.03.004

    Abstract ( 692 )   PDF (1743KB) ( 1094 )  

    Objective To knock out the FLO8 gene in Candida albicans using fusion PCR combined with homologous recombination and analyze drug sensitivity in FLO8 gene knockout strains preliminarily. Methods Upstream and downstream flanking sequences of FLO8 gene were fused with selection markers by fusion PCR to construct homologous knockout fragments, which were then transfected into Candida albicans SN152 by high efficient lithium acetate transfection method. Positive strains were screened on nutritional defect medium and two alleles in FLO8 gene were knocked out by performing the homologous recombination twice. Drug sensitivity was compared between strains with and without FLO8 gene by spot assay. Results The Candida albicans SN152 FLO8-/- double allelic deletion strains were successfully constructed. Drug resistance in FLO8-/- was greater than that in FLO8+/-, which was greater than that in SN152. Conclusion Fusion PCR combined with homologous recombination can rapidly and efficiently construct Candida albicans FLO8 gene deletion strains. Candida albicans FLO8 gene is associated with drug sensitivity and drug resistance increases with the decrease in copy number.

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    Influence of Venenum Bufonis on proliferation and apoptosis in liver cancer cell HepG2 and relevant mechanisms
    FENG Jing, DENG Fei, ZHANG Ping, et al
    2016, 36 (03):  340. 
    doi: 10.3969/j.issn.16748115.2016.03.005

    Abstract ( 626 )   PDF (1504KB) ( 790 )  

    Objective To investigate the influence of Venenum Bufonis on proliferation and apoptosis in liver cancer cell HepG2 and relevant mechanisms. Methods Cell viability CCK-8 method was used to detect the influence of Venenum Bufonis on proliferation in liver cancer cells. Hochest 33258 staining technique was used to observe the influence of Venenum Bufonis on cellular karyotype and the apoptosis was detected by Annexin V-FITC/PI kit and flow cytometry. Rhodamine 123 staining method was used to detect the effect of Venenum Bufonis on mitochondrial membrane potential on flow cytometry. Cells were pretreated with apoptotic factor caspase8/9/3 specific inhibitors and the effect of Venenum Bufonis on cell viability was detected by CCK-8 method. Results Cell viability detection showed that Venenum Bufonis killed cells in an obvious concentration-and time-dependent manner. Confocal microscope observation found that Venenum Bufonis significantly caused nucleus shrivel, which resulted in forming apoptotic body. Treatment with 20 μg/mL Venenum Bufonis for 24 h caused apoptosis in 56.4% of cells and a decrease in mitochondrial membrane potential by 51.9%. Pretreatment with caspase9/3 inhibitors induced more increase in cell viability than treatment with Venenum Bufonis alone. Conclusion Venenum Bufonis can significantly inhibit proliferation in liver cancer cell HepG2 and induce apoptosis. Apoptosis mechanisms may be associated with mitochondrial membrane potential decrease and caspase 9/3 activation.

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    Effects of radiotherapy on microhardness and micromorphology of deciduous tooth enamel
    CHEN Man-shuang, MA Wen-zhu, XU Xiao-hui, et al
    2016, 36 (03):  344. 
    doi: 10.3969/j.issn.16748115.2016.03.006

    Abstract ( 486 )   PDF (2119KB) ( 744 )  

    Objective To investigate the effects of radiation therapy on hard tissue structure of deciduous teeth. Methods Forty healthy and freshly extracted or exfoliated human deciduous molar teeth mesiodistally sectioned to yield buccal and lingual hemisections and forty vestibular sections were selected for enamel experiment following the principle of selfcontrol. Enamel initial hardness was measured by microhardness tester prior to irradiation. Then a total of 40 Gy of irradiation was performed with 2 Gy/time, 1 time/d, 5 times/week for 4 weeks. The enamel hardness was measured after each 10 Gy of irradiation. The microhardness of deciduous teeth was observed by microhardness tester after irradiation and micromorphological changes were observed by scanning electron microscopy (SEM).  Results The microhardness of deciduous teeth enamel decreased with radiation dose. SEM results showed that significant micromorphological changes in enamel surface were seen in all regions of irradiated enamel compared with nonirradiated enamel. With the increase in irradiation dose, surface morphology exhibited a progressive destruction, which appeared an amorphous appearance. Conclusion The microhardness of hard tissue of deciduous teeth decreases with radiation dose. Surface morphology of enamel exhibits a progressive destruction.

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    Effects of deferoxamine on neuroblobin expression and lesions in rats with traumatic brain injury in acute stage
    WANG Kai, JING Yao, XU Chen, et al
    2016, 36 (03):  349. 
    doi: 10.3969/j.issn.16748115.2016.03.007

    Abstract ( 575 )   PDF (996KB) ( 683 )  

    Objective To investigate effects of deferoxamine (DFX) on neuroblobin (Ngb) expression in cerebral penumbra and lesions in rats with traumatic brain injury (TBI) in acute stage. Methods Ninety SD rats were randomly assigned to sham operation group (n=30), experimental group (n=30) and control group (n=30). A controlled cortical impact (CCI) model was established for experimental group and control group. Rats in the sham group underwent the same surgical procedure without injury. Rats in the experimental group were intraperitoneal injected with DFX (100 mg/kg) at 2 and 6 h after TBI and were administrated once every 12 h afterward. Rats in the control group were intraperitoneal injected with the same volume of saline at same time points. At 6, 12, 24 and 48 h after surgery, six rats from each group were sacrificed and brains were harvested. The Ngb expression in cerebral penumbra was detected by RT-PCR and Western blotting. Six rats from each group underwent MRI examination at 3.0T at 3 d after TBI and lesion volumes were calculated on the basis of T2weighted images. Results Ngb mRNA and protein expressions in penumbra significantly increased in early stage after TBI, reached peaks at 12 and 24 h, respectively, and then decreased slowly and maintained fairly high levels until 48 h after TBI. Ngb mRNA and protein expressions at 12, 24 and 48 h after TBI in the experimental group were significantly higher than those in the control group. Lesion volumes at 3 d after TBI in the experimental group were smaller than those in the control group. Conclusion DFX has neuroprotective effect in acute stage after TBI. It can reduce the lesion volume and the protective effect may be associated with inducing the expression of endogenous brain protection factor Ngb.

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    Original article (Clinical research)
    Study on clinical characteristics and risk factors of interstitial lung disease in 117 patients with rheumatoid arthritis
    CHEN Mu-zhi, FU Qiang, FU Qiong, et al
    2016, 36 (03):  359. 
    doi: 10.3969/j.issn.16748115.2016.03.009

    Abstract ( 744 )   PDF (1134KB) ( 874 )  

    Objective To assess clinical characteristics, imaging and laboratory examinations for rheumatoid arthritis (RA) patients combined with interstitial lung disease (RA-ILD) and investigate related risk factors in RA-ILD. Methods Clinical data of 117 RA inpatients admitted by the Department of Rheumatology of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between July 2010 and July 2011 were retrospective analyzed. Clinical indexes such as age, gender, course of disease, history of active or passive smoking, medicine history, rheumatoid factors (RF), as well as anti-cyclic citrullinated peptide antibody (CCP) between RA group and RA-ILD group were compared and risk factors related to RA-ILD were analyzed. Lung high resolution CT (HRCT) images of RA-ILD patients were scored by using an international recognized scoring system to assess the severity of ILD. Correlations between the severity of ILD and above indexes were analyzed. Results Among 117 RA patients, 32 were males and 85 were females. 35 patients were diagnosed with RA-ILD (29.9%, 35/117). 4.3% (19/35) of patients had respiratory symptoms in the RA-ILD group. Ages and RA onset ages in the RA-ILD group were significantly older than those in the RA group (P=0.000 4, P=0.000 08). Proportion of active or passive smoking patients in the RA-ILD group was significantly higher than that in the RA group (P=0.001, P=0.005). Active smoking and passive smoking were independent risk factors in RA-ILD. The severity of ILD in male RA patients was greater than that in female RA patients (P=0.023 6). The onset of ILD was earlier in male RA patients compared with female RA patients (P=0.011 3). The older the RA onset age was, the quicker the development of ILD would be (P=0.004 2, r=-0.472 0). The severity of ILD in RA patients positive for anti-CCP antibody tended to be greater compared with RA patients negative for anti-CCP antibody (P=0.055 3). The severity of ILD was not associated with previous methotrexate or leflunomide administration (P>0.05). Conclusion We found, for the first time as far as we know, that passive smoking is an independent risk factor for ILD development in RA patients. Given that about half of RA-ILD patients only have slight respiratory symptoms, it is important to perform lung HRCT examination in order to achieve early diagnosis. Old age, male and positive for anti-CCP antibody in RA-ILD patients indicate more severe ILD and adequate attention should be paid to them.

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    Analysis of 6year morality and its risk factors in patients undergoing maintenance hemodialysis
    FANG Yan, ZHANG Wei-ming, YAN Yu-cheng, et al
    2016, 36 (03):  364. 
    doi: 10.3969/j.issn.16748115.2016.03.010

    Abstract ( 694 )   PDF (625KB) ( 917 )  

    Objective To analyze deaths of patients undergoing maintenance hemodialysis (MHD) and provide evidence for improving longtime survival in MHD patients. Methods Clinical data of MHD patients admitted in our hospital for the first time from January 1, 2009 to December 31, 2014 were collected and causes of death and related risk factors were analyzed. Results One hundred and seveny-six patients were enrolled. The mean age of starting hemodialysis was 58.2±16.1 years old and the mean duration of follow-up was 37.6±22.0 months. There were 33 patients (18.8%) died and the total mortality was 59.7/1 000 patients/year. The main course of death was cardiovascular and cerebrovascular diseases, which resulted in 15 deaths (45.6%). Compared with the survival group, patients in the death group had an older mean age of starting hemodialysis (P=0.000), higher proportion of patients who smoked and had a history of cardiovascular events (P=0.045, P=0.002), higher starting hemodialysis frequency (P=0.004), lower hemoglobin level and haematocrit before hemodialysis (P=0.011,P=0.012), higher level of serum high sensitivity C reactive protein (P=0.036), and lower creatinine clearance rate (P=0.049). Cox regression analysis showed that the age of starting hemodialysis (HR 1.033, 95%CI 1.007-1.061) and hemoglobin level before hemodialysis (HR 0.980, 95%CI 0.962-0.998) were independent risk factors of death in MHD patients. Conclusion The main cause of death in MHD patients are cardiovascular and cerebrovascular diseases. Older age of starting hemodialysis and lower hemoglobin level before hemodialysis cause higher death risk in MHD patients.

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    Significance of platelet and lymphocyte counts for predicting the prognosis of patients with breast cancer
    HONG Jin, MAO Yan, CHEN Xiao-song, et al
    2016, 36 (03):  369. 
    doi: 10.3969/j.issn.16748115.2016.03.011

    Abstract ( 793 )   PDF (992KB) ( 887 )  

    Objective To analyze the correlation between preoperative platelet count, lymphocyte count and platelet to lymphocyte ratio (PLR) in peripheral blood and the prognosis in operable patients with invasive breast cancer. Methods A retrospective analysis of 487 female patients who were diagnosed with invasive breast cancer and underwent surgery and adjuvant therapies at Ruijin hospital, Shanghai Jiao Tong University School of Medicine from January 2009 to December 2010 was performed. Disease free survival (DFS) and overall survival (OS) were assessed using KaplanMeier method and compared using logrank test. Multivariate analysis employed Cox proportional hazard model. Results The median follow-up time was 55 months. KaplanMeier survival curve analysis revealed that the differences in 5year DFS and OS between patients in high platelet count and low platelet count groups or high lymphocyte count and low lymphocyte count groups were not statistically significant. Patients in the high PLR (≥110.16) group had a much lower 5year DFS compared with patients in the low PLR group (81.2% versus 87.1%, P=0.021). The differences in 5year OS between patients in the high PLR group and the low PLR (<110.16) group was not statistically significant (898% versus 931%, P=0.273). Cox proportional hazard model multivariate analysis revealed that patients in the high PLR group had a much lower DFS compared with patients in the low PLR group (HR=1.796, 95%CI=1.116-2.892, P=0.016). Conclusion PLR is an independent factor for predicting disease free survival in patients with invasive breast cancer, while platelet count and lymphocyte count in peripheral blood are not significant correlated to the prognosis of breast cancer.

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    Analysis of referral factors for fetal echocardiography in second and third trimesters
    WANG Jian, WU Yu-rong, ZHAO Li-qing, et al
    2016, 36 (03):  375. 
    doi: 10.3969/j.issn.16748115.2016.03.012

    Abstract ( 705 )   PDF (743KB) ( 707 )  

    Objective To analyze the correlation between referral indications for fetal echocardiography and prenatally detected fetal cardiac abnormalities. Methods 1 032 pregnant women referred for fetal echocardiography were retrospectively analyzed. All referral cases were assigned to singleindication and multiindication groups. The distribution of referral indications was analyzed, the rate of prenatally detected fetal cardiac abnormalities was obtained, and the correlation between referral indications and prenatally detected fetal cardiac abnormalities was assessed. Results In the singleindication group, 172 cases of fetal cardiac abnormalities (19.4%) were detected in 885 referral cases. Logistic regression analysis demonstrated that suspected cardiac views detected by routine second trimester fetal malformation screening were associated with prenatally diagnosed fetal cardiac abnormalities (OR=13.7; 95%CI=9.40-20.00). Isolated strong intracardiac echogenic foci were negatively correlated to prenatally detected fetal cardiac abnormalities (OR=0.24; 95%CI=0.11-0.56). The rate of prenatally detected fetal cardiac abnormalities increased to 27.2% (P=0.336) in the multiindication group. For cases with fetal indication, the risk of prenatally detected fetal cardiac abnormalities significantly increased. Conclusion As an isolated referral indication, suspected cardiac views detected by routine second trimester fetal malformation ultrasound screening are associated with prenatally detected fetal cardiac abnormalities, while isolated strong intracardiac echogenic foci should no longer serve as a referral indication for fetal echocardiography. For pregnant women with multiple referral indications for fetal echocardiography, if one of them is fetal indication, the rate of prenatally detected fetal cardiac abnormalities will be much higher.

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    Treatment of refractory interstitial cystitis/painful bladder syndrome by percutaneous hypogastric nerve block
    YI Qing-tong, Lü Jian-wei, WANG Yong-lei, et al
    2016, 36 (03):  380. 
    doi: 10.3969/j.issn.16748115.2016.03.013

    Abstract ( 702 )   PDF (877KB) ( 721 )  

    Objective To assess the efficacy and safety of percutaneous hypogastric nerve block (HNB) in treating refractory interstitial cystitis/painful bladder syndrome (IC/PBS). Methods Clinical data of 78 female patients with refractory IC/PBS were retrospectively analyzed. Puncture needles were guided to both hypogastric sympathetic nerves by CT and electrical stimulation detector. Patients were injected with 20 mL 2% lidocaine, 0.25 mg methycobal and 20 mg triamcinolone acetonide. This treatment was performed once per 2 weeks with 3 times per course. Mean visual analogue scale (VAS) scores, O’LearySant interstitial cystitis patient symptom index (ICSI) scores and patient problem index (ICPI) scores, urination frequency in 24 hours and mean urinary output per time 1 week before treatment and 1 week, 1, 3, 6, 9 and 12 months after treatment were compared. Adverse events during the treatment were observed. Results All 78 patients completed 3 rounds of HNB. Effective rates 1 week, 1, 3, 6, 9 and 12 months after treatment were 795%, 79.5%, 67.9%, 55.1%, 30.8% and 16.7%, respectively. Efficacy was gradually decreased with time. Maintain time for symptom relief was 3-17 (8.5±2.8) months. Remission rate of bladder pain or discomfort was higher than that of frequent or urgent urination. The differences in VAS scores, ICSI scores, ICPI scores, urination frequency in 24 hours and mean urinary output per time between before treatment and 1 week, 1, 3, 6, 9 and 12 months after treatment were statistically significant (P=0.000 0). No significant adverse event was observed during the treatment. Conclusion Percutaneous HNB can alleviate clinical symptoms in some patients with refractory IC/PBS with less injury and adverse reactions.

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    Assessment of efficacy of medication combined with WeChat platform for quitting smoking in patients with chronic obstructive pulmonary disease
    YANG De-xiang, GU Chen-juan, NI Lei, et al
    2016, 36 (03):  385. 
    doi: 10.3969/j.issn.16748115.2016.03.014

    Abstract ( 823 )   PDF (666KB) ( 832 )  

    Objective To assess the efficacy of medication combined with WeChat platform for quitting smoking in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 146 COPD patients undergoing quitting smoking intervention were randomly selected between October 2014 and September 2015 by prospective design. One hundred and twenty patients were completely followed up and were assigned to non-drug group (n=38), drug group (n=40) and drug and WeChat group (n=42) according to follow-up methods. All patients were intervened with brief persuasion method and the drug group was treated with varenicline tartrate. Clinical data of nicotine-dependent COPD smoking quitters were analyzed. Successful withdrawal rate of medication or nonmedication and their influencing factors were assessed. Assessment indexes included 7 d point withdrawal rates and sustained withdrawal rates in the first, third and sixth months. Results The 7 d point withdrawal rate in the drug group in the first month was lower than that in the non-drug group (χ2=7.255 9, P=0.023), while those in the drug group in the third and sixth months were higher than those in the non-drug group (χ2=15.283 7, P=0.000;χ2=28.260 3, P=0.000). The differences between the drug and WeChat group and the drug group were not statistically significant (χ2=2.235 1, P=0.125; χ2=0.204 6, P=0.892; χ2=0.244 1, P=0.507). The sustained withdrawal rates in the drug group in the third and sixth months were higher than those in the non-drug group (χ2=11.214 5, P=0.004; χ2=13.278 9, P=0.001). The sustained withdrawal rate in the drug and WeChat group in the third month was higher than that in the drug group (χ2=5.222 4, P=0.022). The difference in sustained withdrawal rate in the sixth month between two groups was not statistically significant (χ2=1.239 7, P=0.237). Conclusion For nicotinedependent COPD patients, medication-assisted quitting smoking can significantly increase the withdrawal rate. Follow-up, propaganda and education via WeChat platform can efficiently promote the quitting smoking process and is helpful for improving the surveillance of drug adherence and withdrawal reactions.

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    Study on the efficacy of combined mitral valve repair techniques in treating complex mitral insufficiency
    MA Wen-rui, ZHANG Wei, YE Wei, et al
    2016, 36 (03):  390. 
    doi: 10.3969/j.issn.16748115.2016.03.015

    Abstract ( 596 )   PDF (533KB) ( 781 )  

    Objective To investigate the therapeutic efficacy of using multiple mitral valve repair techniques in treating patients with complex mitral insufficiency. Methods Two or more repair techniques were used for treating 76 patients with moderate or severe mitral regurgitation. The closure of mitral valve was examined perioperatively by transesophageal echocardiography (TEE) and valve regurgitation was examined by transthoracic echocardiography (TTE) before discharge. The closure of mitral valve and relevant left heart parameters in short and medium terms were followed up. Results The perioperative TEE results showed that the closure of mitral valve in 9737% (74/76) of patients reached satisfactory outcome after using combined repair techniques. TTE results before discharge were consistent with TEE results. 6-72 months of followup showed that the closure of mitral valve in 9342% (71/76) of patients reached satisfactory outcome with significant higher left ventricular ejection fractions and lower left ventricular end diastolic diameters compared with preoperative data. Conclusion Combined mitral valve repair techniques are efficient for treating complex mitral insufficiency and the choice of combined surgical procedure should be based on pathological changes in patient valves and surgeons mastery of repair techniques.

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    Correlation between changes in cancer antibody 125 level in dialysate and prognosis in peritoneal dialysis patients
    CHEN Qi-jie, FANG Wei, YAN Hao, et al
    2016, 36 (03):  393. 
    doi: 10.3969/j.issn.16748115.2016.03.016

    Abstract ( 627 )   PDF (1175KB) ( 804 )  

    Objective To investigate the effects of changes in cancer antibody 125 (dCA125) level in dialysate from peritoneal dialysis (PD) patients on the prognosis. Methods Patients undergoing continuous ambulatory PD for more than 12 months in PD Center of Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2005 to December 31, 2009 and with complete data were enrolled. dCA125 levels in dialysate from enrolled patients were measured at the beginning of PD and after 12 months of PD. Patients were assigned to stable dCA125 group and elevated dCA125 group according to the median of dCA125 level changes. All patients were followed up until death, quitting PD, transferring to other centers, lost contact or study termination date (June 30, 2014). KaplanMeier method was used to compare survival, technique survival and peritonitisfree survival time between two groups. Cox proportional hazards model was used to analyze independent risk factors related to the prognosis of patients. Results A total of 111 patients were enrolled with 53 males (477%), a mean age of (535±147) years and 27 diabetic patients (24.3%). The differences in baseline demographics and clinical indexes between two groups were not statistically significant (P>005). Patients in the stable dCA125 group (n=55) developed 73 episodes of peritonitis and the mean incidence of peritonitis was 1/500 patient months. Patients in the elevated dCA125 group (n=56) developed 44 episodes of peritonitis and the mean incidence of peritonitis was 1/753 patient months. The peritonitisfree survival time in the stable dCA125 group was significantly shorter than that in the elevated dCA125 group (logrank 6133, P=0013). The differences in long term survival (logrank 2108, P=0147) and technique survival (logrank 0108, P=0743) between two groups were not statistically significant. Cox proportional hazards model analysis showed that elevated dCA125 level was an independent protective factor for peritonitis (HR 0538,95%CI 0296~0979,P=003). Conclusion Elevated dCA125 level in PD patients is a protective factor for peritonitis and changes in dCA125 level are unrelated to longterm survival and technique survival. Detection of changes in dCA125 level may predict the incidence of peritonitis in PD patients.

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    Analysis of correlation between clinicopathologic factors and prognosis of primary gastrointestinal stromal tumors
    ZHAO Ling, CHEN Xiao-yu, LIU Qiang, et al
    2016, 36 (03):  399. 
    doi: 10.3969/j.issn.16748115.2016.03.017

    Abstract ( 628 )   PDF (1387KB) ( 1027 )  

    Objective To analyze the correlation between clinicopathologic factors and prognosis of primary gastrointestinal stromal tumors (GISTs). Methods The clinicopathologic data of 166 patients with primary GISTs were analyzed. The progression-free survival (PFS) of patients was compared using KaplanMeier method. The clinicopathologic factors affecting the prognosis of patients were investigated by univariate and multivariate analysis. Results Univariate analysis revealed that the prognosis of patients was associated with primary location, tumor size, mitotic index, invasion of surrounding tissues, necrosis, NIH risk and Ki-67 index. Multivariate analysis indicated that tumor size, invasion of surrounding tissues, necrosis, NIH risk and Ki-67 index were independent factors affecting the prognosis of patients. Conclusion The prognosis of primary GISTs can be assessed by combining the classical NIH risk classification, Ki-67 index and invasion of surrounding tissues.

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    Correlation between circulating CD34+ level and elderly patients with hypertension  
    HUANG Li-ying, SHEN Pei-xiao, WANG Hai-ya
    2016, 36 (03):  403. 
    doi: 10.3969/j.issn.16748115.2016.03.018

    Abstract ( 568 )   PDF (604KB) ( 822 )  

    Objective To explore the correlation between circulating CD34+ cell level and elderly patients with hypertension and analyze Ang-1/Tie-2 expression in endothelial progenitor cells and its regulatory meaning. Methods Fiftynine elderly patients with hypertension and 59 healthy people were enrolled and assigned to the hypertension group and the control group, respectively. The mRNA level of Ang-1/Tie-2  was measured by RTPCR. Flow cytometry was used to detect the CD34+/PMNC value in peripheral blood. The correlations between CD34+/PMNC value in peripheral blood and clinical indexes and between Ang-1 and Tie-2  mRNA levels and CD34+/PMNC value were analyzed. Results The CD34+/PMNC value in peripheral blood of the hypertension group was significantly lower than that of the control group (P=0.000). The CD34+/PMNC value in peripheral blood of the hypertension group was negatively correlated to systolic pressure (r=-0.622; P=0.009), while was not correlated to diastolic pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol levels, fasting blood glucose and uric acid. The Ang-1 and Tie-2 mRNA levels in endothelial progenitor cells of the hypertension group were significantly lower than those in the control group (P=0.000) and were positively correlated to CD34+/PMNC value (r=0.561,P=0.005;r=0.473,P=0.009). Conclusion Cardiovascular lesions in elderly patients with hypertension may be associated with the downregulation of Ang-1 and Tie-2 levels, which affects repair function of endothelial progenitor cells.

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    Correlation of atrial fibrosis and atrial fibrillation after coronary artery bypass grafting
    FAN Yong-liang, MAO Jian-qiang, ZHUANG Yu, et al
    2016, 36 (03):  407. 
    doi: 10.3969/j.issn.16748115.2016.03.019

    Abstract ( 550 )   PDF (1154KB) ( 702 )  

    Objective To investigate the correlation between atrial fibrosis and atrial fibrillation after coronary artery bypass grafting (CABG). Methods Forty-seven patients with coronary atherosclerotic heart disease were assigned to the atrial fibrillation group and non-atrial fibrillation group (control group) according to whether atrial fibrillation occurred after CABG. Right atrial appendage sample was harvested before cardiopulmonary bypass. Collagen fiber content in samples was semi-quantitatively measured after Masson staining. Myocardial collagen volume fraction (CVF) in atrial tissues was calculated and atrial fibrosis was assessed. Results Among 47 patients undergoing CABG, 15 (31.9%) of them developed postoperative atrial fibrillation. Myocardial CVF was 21.6%±8.1% (4.1%-39.1%). Analysis by group showed that the age in the atrial fibrillation group was significantly older than that in the control group (P=0.032). Myocardial CVFs in the atrial fibrillation group and the control group were 25.4%±7.9% and 19.9%±7.7%, respectively. Myocardial CVF in the atrial fibrillation group was significantly higher than that in the control group (P=0.020). The differences in other preoperative, intraoperative and postoperative data between two groups were not markedly. Correlation analysis showed that the age of patients was significantly correlated to myocardial CVF (r=0.876, P=0.007). Conclusion The age is significantly correlated to atrial fibrosis and atrial fibrosis is correlated to atrial fibrillation after CABG. Atrial fibrosis may be one of important mechanisms of developing atrial fibrillation after CABG.

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    Study on the correlation between rs9332739 in complement component 2 gene and agerelated macular degeneration
    SONG Ying, ZHANG Lin
    2016, 36 (03):  411. 
    doi: 10.3969/j.issn.16748115.2016.03.020

    Abstract ( 593 )   PDF (535KB) ( 695 )  

    Objective To investigate the correlation between single nucleotide polymorphism (SNP) rs9332739 in complement component 2 (C2) gene and advanced age-related macular degeneration (AMD). Methods 204 advanced AMD patients and 352 healthy controls in Shanghai were enrolled. Venous blood samples were collected and DNA was extracted using standard phenol-chloroform method. Genotypes on SNP rs9332739 in C2 gene in advanced AMD patients and controls were determined using TaqMan SNP genotyping assay. Fishers exact test, χ2 test and logistic regression test were used to analyze correlation between rs9332739 and advanced AMD. Results Compared with the control group, minor allele C on SNP rs9332739 in the advanced AMD group had an OR of 1.61 and P of 0.55, which had no statistical significance. P value of rs9332739 genotypes (CG/GG/CC) was 0.89 in additive and dominant models after adjusted for age and sex and had no statistical significance. The differences in three rs9332739 genotypes between two phenotype in advanced AMD, namely dry AMD and wet AMD, were not statistically significant (P=0.51). Conclusion The minor allele C on SNP rs9332739 in C2 gene is not a risk factor for the incidence of advance AMD in Chinese Han population. Genotype is not significantly associated with the incidence of AMD. rs9332739 may not be a major genetic marker in advance AMD. More samples are needed for further validation and investigation.

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    Original article (Public health)
    Preliminary system dynamics study on incidence of cardiovascular disease
    CHENG Jie, SHI Li-li, JIANG Jun-jie, et al
    2016, 36 (03):  414. 
    doi: 10.3969/j.issn.16748115.2016.03.021

    Abstract ( 629 )   PDF (1193KB) ( 935 )  

    Objective To build a system dynamics simulation model for incidence of cardiovascular disease (CVD) in Shanghai registered population, simulate the development process of CVD and predict the development trend. Methods A system dynamics model structure for incidence of CVD was constructed according to current studies on risk factors in CVD. Data of related risk factors were obtained via literature research. The corresponding model was simulated, corrected, and verified. Results The resultant model simulated the data of CVD during 2002-2010 in Shanghai registered population and simulation results matched the historical data very well. The incidence of CVD in Shanghai registered population in 2020 was predicted based on successful data test. Conclusion This model can simulate and predict the annual increase in CVD population in Shanghai registered population if risk factors in CVD are not affected and provide theoretic support for developing efficient intervention policies.

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    Effects of vegetarian type and duration on body composition in 235 Shanghai vegetarians
    MAO Xuan-xia, SHEN Xiu-hua, TANG Wen-jing, et al
    2016, 36 (03):  418. 
    doi: 10.3969/j.issn.16748115.2016.03.022

    Abstract ( 628 )   PDF (597KB) ( 905 )  

    Objective To explore the effects of vegetarian type and duration on body composition in vegetarians. Methods Two hundred and thirty-five healthy adult vegetarians willing to be surveyed were enrolled from 10 vegetarian restaurants in Shanghai from April 2012 to July 2013. Vegetarians were assigned to vegan group (n=99) and lacto-ovo-vegetarian group (n=136) according to vegetarian type and <5 year group (n=157) and ≥ 5 year group (n=78) according to vegetarian duration. Vegetarians were surveyed with questionnaires. Their body height and weight were measured and body composition was detected by a human body composition analyzer. Results Multivariate analysis showed that differences in body composition indexes such as body protein, skeletal muscle, body mineral and body fat between the vegan group and the lacto-ovo-vegetarian group were not statistically significant after adjusted for age, sex and vegetarian duration (P>0.05). The difference in the risk of overweight/obesity between two groups was not significant after adjusted for age, sex, vegetarian duration and dietary energy intake (P>0.05), but the risk of central obesity in the lacto-ovo-vegetarian group was markedly lower than that in the vegan group (OR=0.164, 95%CI 0.048-0.554, P=0.004). The differences in above indexes between the <5 year group and the ≥ 5 year group was not statistically significant (P>0.05). Conclusion Different vegetarian types and durations have no obvious impact on body composition indexes. The risk of central obesity in lacto-ovo-vegetarians may be lower than that in vegans, but further studies are needed to confirm this finding.

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    Establishment of an internal reporting system of medical adverse events based on hospital informatization
    YANG Jing, ZHANG Jing, ZHANG Zhi-ruo, et al
    2016, 36 (03):  423. 
    doi: 10.3969/j.issn.16748115.2016.03.023

    Abstract ( 1137 )   PDF (975KB) ( 1008 )  

    Objective To explore the establishment of internal network reporting system of medical adverse events based on the hospitalization information system and cooperative office system, unify the classification criteria, and normalize reporting terms in order to improve the reporting efficiency for adverse events and optimize medical safety management. Methods Combined with previous qualitative and quantitative research results, the internal reporting system of medical adverse events was designed and established based on the hospital information system according to retrieved literature on reporting system of medical adverse events both at home and abroad. Results The internal reporting system of medical adverse events, which consisted of five functional modules, namely event reporting, events inquiry, statistics and analysis, authority management and system setting, was established. The reporting system can be embedded in the electronic medical record system and circulate in the cooperative office system. Realized key technologies included staging reporting, precise classification, classification and screening of reporting factors, and unified and normalized default settings. The system also took into account the clinical operability, as well as standardization and integrity of data collection. Conclusion The application of the reporting system can increase the reporting efficiency for adverse events, thus improving the reporting willingness of clinicians to a certain extent. The information collected by the system is convenient for functional departments to perform data statistics and analogy analysis, summarize regular problems in adverse events, identify system risks, and develop improving measures, so as to elevate the efficiency of medical safety administration.

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    Analysis of management efficacy of special clinical antibiotic use rectification in obstetrical and gynecological hospitals
    ZHANG Chen, JIANG Jian-fen, CHEN Shu-fang, et al
    2016, 36 (03):  427. 
    doi: 10.3969/j.issn.16748115.2016.03.024

    Abstract ( 603 )   PDF (737KB) ( 776 )  

    Objective To investigate clinical antibiotic use and assess management efficacy in obstetrical and gynecological hospitals before and after the special antibiotic rectification. Methods The data of clinical antibiotic use in the hospital information system from 2010 to 2014 were retrieved and retrospectively analyzed and summarized according to indexes proposed by the 2011 National Special Rectification Program for Clinical Antibiotic Use. Results The ratios of the amount of used antibiotics to the total amount and clinical antibiotic prescriptions to total prescriptions and antibiotic use rates in inpatients and type Ⅰ incision operations decreased from 18.53%, 16.54%, 73.53% and 67.17% before rectification (2010) to 3.75%, 8.82%, 41.25% and 11.88% after rectification (2014), respectively, which met the requirements of the National Health and Family Planning Commission. The decline tendency was statistically meaningful (P=0.000). Other indexes such as antibiotic use density (AUD) and sample test rates for patients received antibiotic therapy were also achieved the requirements of the National Health and Family Planning Commission. Conclusion The clinical antibiotic use is more reasonable and the management efficacy is significant via the special antibiotic rectification.

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    Analysis on main death causes and potential life lost in Chongqing permanent residents in 2013
    LUO Lin, CHEN Yu
    2016, 36 (03):  431. 
    doi: 10.3969/j.issn.16748115.2016.03.025

    Abstract ( 585 )   PDF (1011KB) ( 835 )  

    Objective To analyze main causes of death and potential life lost in Chongqing permanent residents in 2013, understand characteristics of death causes and provide reference evidence for developing reasonable health prevention and control measures. Methods The data of death causes in Chongqing permanent residents in 2013 were classified according to the International Classification of Diseases (ICD-10) and statistically analyzed with death cause analysis software DeathReg 2005 and SPSS 13.0. Characteristics of death causes in Chongqing permanent residents were described by mortality, constituent ratio of death cause, ranking of death cause, potential years of life lost (PYLL) and average years of life lost (AYLL). Results The mortality was 671.08 per 100 000 people in 2013. Standardized mortality was 475.72 per 100 000 people and the mortality was higher in males than in females (χ2=8 128.081,P=0.000). The top 5 death causes were circular system diseases, tumors, respiratory system diseases, injuries and poisoning, and digestive system diseases. Rankings of different death causes were different (χ2=3 562.187, P=0.000). These 5 death causes accounted for 92.88% of all deaths Deaths caused by lung cancer accounted for 47.01% of all tumorcaused deaths, which was more than the national average level in 2012. Death cause rankings in different age groups were different. Potential life lost analysis showed that tumors, injuries and poisoning, circulatory system diseases, respiratory diseases and digestive system diseases were top 5 causes for early death in residents. Conclusion In  2013, main death causes in Chongqing permanent residents are chronic noninfectious diseases such as tumors and circulatory system diseases. Injuries and poisoning and especially traffic accidents are main death causes in children and young adults. Disease control and prevention strategies should be developed according to different death cause characteristics in Chongqing residents.

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    Review
    Research progress of bone-targeting estrogen-like drugs in treatment of osteoporosis
    HU Yan, GAO Yan-hong
    2016, 36 (03):  437. 
    doi: 10.3969/j.issn.16748115.2016.03.026

    Abstract ( 657 )   PDF (698KB) ( 860 )  

    Estrogen-like drugs are efficient for prevention and treatment of osteoporosis. In order to improve absorptivity and bioavailability for estrogen-like drugs in human body, enhance affinity between estrogen-like drugs and skeletal system, and reduce adverse reactions due to long term administration, new improvements in estrogen-like drugs have been made in terms of drug targeting and drug synthesis in recent years. Estrogen controlled release nano-carriers and some small peptide, tetracycline and RGD-peptide bone-targeting drugs are widely used, which provide novel methods and ideas for osteoporosis treatment. In this paper, research progresses of estrogen-like drugs are reviewed.

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    Quorum sensing inhibitors on biofilm formation
    FENG Mengdie, HONG Yu, MAO Pujia, et al
    2016, 36 (03):  442. 
    doi: 10.3969/j.issn.16748115.2016.03.027

    Abstract ( 903 )   PDF (634KB) ( 869 )  

    Biofilms are complexes resulting from microbial sessile communities attached to a substratum or interface and embedded in a self-produced extracellular matrix, which can provide a protective layer for bacteria, block antibiotic entry, and allow bacteria to exhibit antibiotic resistance. Clinical statistics showed that about 80% of microbial infections are associated with quorum sensing-mediated biofilms. Thus it is essential to inhibit the formation of biofilm in order to cure pathogen infections. Quorum sensing (QS) molecules are involved in biofilm formation, while QS inhibitors (QSI) can inhibit biofilm formation. This papers reviews advances of QSI in anti-biofilm.

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    Research progresses of antibacterial activity and biological safety of graphene oxide
    ZHU Xiao-dan, TANG Zi-sheng
    2016, 36 (03):  447. 
    doi: 10.3969/j.issn.16748115.2016.01.028

    Abstract ( 816 )   PDF (581KB) ( 1108 )  

    In recent years, as a new type of nanomaterials, graphene has attracted considerable attention of many different fields because of its unique physicochemical and material properties. Graphene oxide (GO) is one of its derivatives. The surface of GO contains various oxygenated functional groups, which result in better water solubility than graphene. Therefore, the potential applications of GO in biological medicine field is quite promising. This paper reviews research progresses of the antibacterial activity and biological safety of GO.

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    Impacts of arginine on early growth and development of human body
    HUANG Zhen-ru, CAI Mei-qin
    2016, 36 (03):  451. 
    doi: 10.3969/j.issn.16748115.2016.03.029

    Abstract ( 610 )   PDF (564KB) ( 879 )  

    Arginine, as a conditional essential amino acid, promotes early growth and development of human body through a variety of ways. This paper summarizes important roles of arginine in the development process of the placenta, embryo and postnatal offspring and associated mechanisms, describes concerned safety issue of adding arginine, and presents future directions for arginine research.

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    Brief original article
    Anatomic study on reconstruction of coracoclavicular ligaments and clinical significance
    ZHU Nai-feng, ZHANG Yun-long, CHEN Yun-feng
    2016, 36 (03):  455. 
    doi: 10.3969/j.issn.16748115.2016.03.030

    Abstract ( 713 )   PDF (523KB) ( 767 )  

    Objective To measure anatomic data of the coracoclavicular ligaments and provide necessary anatomic evidence for complete anatomic reconstruction of coracoclavicular ligaments for surgical treatment of dislocation of acromioclavicular joint. Methods A total of 15 adult cadavers (30 shoulders) were selected. The centers of trapezoid ligament and conoid ligament on the clavicle were marked and anatomic data between centers and bone landmarks on the clavicle was measured. Results The distances from the center of trapezoid ligament on the clavicle to the lateral end, anterior border, and posterior border of clavicle were (21.87±1.12) mm (19.8-24.0 mm), (6.34±0.45) mm (5.5-7.2 mm), and (20.47±1.02) mm (18.9-22.1 mm), respectively. The distances from the center of conoid ligament on the clavicle to the lateral end, anterior border, and posterior border of clavicle were (36.69±0.92) mm (35.0-38.5 mm), (15.71±0.56) mm (14.8-17.0 mm), and (5.53±0.39) mm (5.0-6.3 mm), respectively. Conclusion Measurement of the distances between centers of trapezoid ligament and conoid ligament on the clavicle and bone landmarks is helpful for complete anatomic reconstruction of coracoclavicular ligaments for surgical treatment of dislocation of acromioclavicular joint.

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    Technique and method
    Determination of l-OTS level and optical purity by ultra performance convergence chromatography method
    XIE Yi-fan, YANG Ruo-lin, LIU Hui-zhong, et al
    2016, 36 (03):  459. 
    doi: 10.3969/j.issn.16748115.2016.03.031

    Abstract ( 689 )   PDF (1052KB) ( 857 )  

    Objective To develop an ultra performance convergence chromatography (UPC2) method for determining l-OTS level and optical purity. Methods Reference substance method was used for quantitative determination. The separation of enantiomers was achieved on a chiral chromatographic column ACQUITY UPC2TM TrefoilTMAMY1(3.0 mm×50 mm, 2.5 mm) at the column temperature of 30 ℃ with the mobile phase of supercritical carbon dioxide-0.2% DEA in 2-propanol (95∶5) at a flow rate of 1.0 mL/min. Detection wavelength was set at 227 nm (compensation reference was 310-360 nm). Results l-OTS and its enantiomer (d-OTS) were effectively separated with the resolution of 2.30. Peak area was linear to mass concentration within the concentration rang of 40-1 000 mg/L (r=0.999 9, n=7). Average recovery was 99.8% (n=9) and the sample was stable within 24 h (RSD=0.81%). The LOD was 5 ng (S/N=4). Conclusion This method is simple and quick and can be used for determining l-OTS level and analyzing optical purity, which has been validated by methodology.

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