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29 August 2016, Volume 36 Issue 08 Previous Issue    Next Issue
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Inside front cover
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Original article (Clinical research)
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Project introductionShanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support 2016, 36 (08):  1106.  Abstract ( 5928 )   PDF (25379KB) ( 2918 )   Related Articles | Metrics

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Translational medicine 2016, 36 (08):  1107.  Abstract ( 517 )   PDF (3794KB) ( 1215 )   Related Articles | Metrics

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Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support—Gainers from Shanghai Jiao Tong University School of Medicine 2016, 36 (08):  1108.  Abstract ( 750 )   PDF (1906KB) ( 768 )   Related Articles | Metrics

Expert forum

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Paradigm shift from basic biomedical research to clinical research for achieving top quality clinical research ZHU Jian-zheng, ZHU Li-jun, CHENG Sha-ni, WANG Hao, DU Ye-ye, PAN Wan-rong, XU Xiao-jing, LIU Hui-jun, ZHOU Shan-sheng, ZHU Hai-ying,MOU Shan 2016, 36 (08):  1109.  doi: 10.3969/j.issn.1674-8115.2016.08.001 Abstract ( 947 )   PDF (4190KB) ( 1614 )   Medical research includes basic biomedical research and clinical research. The latter is limited by multiple factors including the failure to appreciate the significance of clinical research, the lack of research funding and specialized teams, the improper evaluation system, the lack of the standardization in data integration and so on. Therefore, the following steps should be taken to strengthen the clinical research. Firstly, the teams of research doctors and clinical scientific researcher have to be constructed, and clinical resources have to be converted into research resources by embracing novel concepts. Secondly, the institutional infrastructure should be transformed to recruit, educate and motivate the excellent researchers and clinicians. Thirdly, the investment should be increased, and the guidance of scientific research funding should be strengthened. Fourthly, the data platform , standardized biobank and unified database system have to be built. Finally, the international collaboration should be strengthened, and the building of multicenter research network for randomized controlled trials should be speed up. Related Articles | Metrics

Original article (Basic research)

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Effects of recombinant angiotensin-converting enzyme 2 on renal caspase signaling and apoptosis in apolipoprotein E-deficient mice ZHANG Zhen-zhou, XU Ran, CHANG Qing, XU Ying-le, JIN Hai-yan, CHEN Lai-jiang, SONG Bei, ZHONG Jiu-chang 2016, 36 (08):  1115.  doi: 10.3969/j.issn.1674-8115.2016.08.002 Abstract ( 848 )   PDF (12295KB) ( 1001 )   Objective · To investigate the alterations in renal caspase signaling and apoptosis in apolipoprotein E (ApoE)-knockout (KO) mice and the effects of recombinant angiotensin-converting enzyme 2 (rACE2) on these alterations. Methods · The ApoEKO mice aged 11- or 12-week were infused with 1.5 mg/kg of Ang Ⅱ and/or 2 mg/kg of recombinant ACE2 (rACE2) per day for 2 weeks. Alterations in renal caspase signaling and renal cell apoptosis were determined with Western blotting and TUNEL method, respectively. Results · The renal cell apoptosis level was elevated in the ApoEKO mice as compared with the wild-type controls. Ang Ⅱ infusion promoted the increases in systolic blood pressure, renal cell apoptosis, expressions of cleaved caspase-3 and cleaved caspase-8, and levels of plasma urea nitrogen and creatinine, which could be revered by rACE2 intervention. Conclusion · The rACE2 treatment can lower the elevated blood pressure induced by Ang Ⅱ in ApoEKO mice and significantly improve renal cell apoptosis and kidney function, which suggest that ACE2 has certain protective effect on atherosclerotic renal injury. Related Articles | Metrics

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Association between cancer relapse and p53 hotspot mutations WANG Huan-bin, XU Jie 2016, 36 (08):  1121.  doi: 10.3969/j.issn.1674-8115.2016.08.003 Abstract ( 1177 )   PDF (8475KB) ( 1086 )   Objective · To investigate the association between different p53 mutations and cancer relapse. Methods · Cancer patients in The Cancer Genome Atlas (TCGA) and MSKCC bladder cancer dataset were stratified according to TP53 genotypes and compared for the relapse-free survival (RFS). Results · Missense mutations at R248 and R282 positions were significantly associated with shorter RFS (P<0.05, HR>2). Although increased hazard ratios were also found for hotspot mutations at R175, G245, and R273 positions, no statistical significance was reached. When mutations of the same type were considered as a cluster, hotspot mutations (but not all missense mutations) were associated with shorter RFS. Frameshift mutations and nonsense mutations had similar effects on RFS. Conclusion · Not all p53 hotspot mutations are associated with shorter RFS, suggesting that p53 hotspot mutations should be differentially treated as different tumor markers.   Related Articles | Metrics

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Expression of SPARC in colorectal cancer and mechanisms of its effects on cancer cell invasion SHEN Chao-qin, YAN Ting-ting, CHEN Hao-yan, FANG Jing-yuan, HONG Jie 2016, 36 (08):  1127.  doi: 10.3969/j.issn.1674-8115.2016.08.004 Abstract ( 1164 )   PDF (17778KB) ( 1022 )   Objective · To analyze the expression of secreted protein acidic and rich in cysteine (SPARC) in colorectal cancer (CRC) and investigate the role of SPARC in CRC cell invasion and relevant mechanisms. Methods · Bioinformatics data in microarray dataset GSE9348 from Gene Expression Omnibus (GEO) were collected for analyzing the difference in SPARC expression between CRC tissues and normal colorectal tissues. Clinical and prognostic data in microarray dataset GSE12945 from GEO were collected for analyzing the correlation between the expression level of SPARC and the survival time of CRC patients. Univariate Cox survival analysis was used to screen out risk factors influencing the prognosis of CRC patients. Gene set enrichment analysis (GSEA) was performed to gain further insight into the biological pathways involved in CRC progression related to SPARC. Changes in the invasion ability of CRC cell HT29 were observed with Transwell assay after down-regulation of SPARC. Real-time PCR and Western blotting were used to detect the levels of EMT-related genes in HT29 and HCT116 cells after down-regulation of SPARC. Results · The expression of SPARC in CRC tissues was significantly elevated compared with normal colorectal tissues (P = 0.000). The overall survival time was significantly shorter in patients with high expression of SPARC than in patients with low expression of SPARC (P = 0.029). The univariate analysis indicated that lymph node metastasis, distant metastasis, poor histological differentiation, recurrence, and high expression of SPARC were risk factors for the survival time in CRC patients. GSEA analysis showed that genes related to cell migration and wound-healing pathways were enriched in patients with high expression of SPARC. The down-regulation of SPARC in CRC cells could decrease the invasion ability and inhibit the expressions of N-cadherin, TWIST1, and SNAIL2. Conclusion · SPARC is up-regulated in CRC and negatively correlated to the prognosis of patients. SPARC can promote the invasion ability of CRC cells, which may be related to the involvement of SPARC in mesenchymal transition of cells. Related Articles | Metrics

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Whole exome sequencing helps diagnose Muckle-Wells syndrome in a Chinese family with autosomal dominant hearing loss CHEN Peng-hui, YANG Tao 2016, 36 (08):  1135.  doi: 10.3969/j.issn.1674-8115.2016.08.005 Abstract ( 862 )   PDF (5325KB) ( 1604 )   Objective · To analyze the genetic characteristics of Muckle-Wells syndrome in a Chinese family based on a case misdiagnosed as nonsyndromic deafness. Methods · The medical history, family history, physical, and audiological examinations were performed for a deaf patient. The familial pedigree was drawn and genetic characteristics were analyzed. Screening for exons and flanking intron sequences in 138 genes known to be associated with deafness was performed for the proband with deafness-targeted next generation sequencing. The whole exon sequencing was conducted for 3 affected and 1 unaffected familial members. The genotype-phenotype co-segregation was verified with Sanger sequencing for Candidate mutations. Results · The deafness family contained 11 members with 3 generations. Inquiries revealed that 9 of them were deaf with bilateral, late onset, and progressive hearing loss, which was consistent with autosomal dominant inheritance. One hundred and thirty-eight genes known to be associated with deafness were ruled out with deafness-targeted next generation sequencing. The whole exon sequencing revealed an E313K mutation in NLRP3 and the co-segregation between E313K and the deafness phenotype in this family was confirmed by Sanger sequencing. Conclusion · A Chinese family with an autosomal dominant hereditary hearing loss was diagnosed as Muckle-Wells syndrome for the first time. E313K mutation in the NLRP3 gene was identified as the causative gene mutation. Related Articles | Metrics

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Establishment of a high throughput gene detection method for seven pathogenic genes of pheochromocytoma XIE Xiao-yan, SONG Qian-qian, CUI Bin 2016, 36 (08):  1140.  doi: 10.3969/j.issn.1674-8115.2016.08.006 Abstract ( 1163 )   PDF (3480KB) ( 1441 )   Objective · To establish a test method platform system for high throughput sequencing of pathogenic genes of pheochromocytoma and make preparation for including the genetic diagnosis into routine clinical testing. Methods · The bank was constructed for 35 DNA fragments in 7 pathogenic genes (SDHB, SDHC, SDHD, VHL, MAX, TMEM127, and RET) of pheochromocytoma with two-step PCR method of high throughput sequencing. The high throughput sequencing was performed on illumine Miseq machine. Results · Thirty-five DNA fragments were detected on illumine Miseq machine and the uniformity met the design of experiment. Conclusion · This method completed the gene detection for 7 pathogenic genes of pheochromocytoma. The quality and cost of the experiment achieved the expectation. Related Articles | Metrics

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Analysis of clinicopathologic features and prognosis of IgA nephropathy patients with H factor deposition in renal tissue YANG Meng, XIE Jing-yuan, OUYANG Yan, ZHANG Xiao-yan, PAN Xiao-xia, XU Jing, WANG Zhao-hui, WANG Wei-ming, CHEN Nan 2016, 36 (08):  1144.  doi: 10.3969/j.issn.1674-8115.2016.08.007 Abstract ( 866 )   PDF (10612KB) ( 870 )   Objective · To investigate the association between clinicopathologic features of H factor (CFH) deposition in renal tissue of patients with IgA nephropathy (IgAN) and the prognosis. Methods · The primary IgAN patients who were confirmed by renal biopsy and were followed for at least 1 year by the Department of Nephrology at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine were enrolled. CFH deposition in renal tissue was detected by immunohistochemistry. Serum CFH level was measured by Enzyme Linked Immunosorbent Assay (ELISA). The baseline clinical data, pathological data, and prognosis were recorded. The end point of the study was defined as a decrease in eGFR by 30% or eGFR<15 mL/(min · 1.73 m2) or receiving renal replacement therapy. Results · A total of 283 patients with IgAN were recruited. Renal pathological examinations revealed that 198 (70%) of them had CFH deposition in renal tissue. Patients with positive CFH deposition had higher urine protein excretion and serum uric acid levels and renal pathology showed severer mesangial proliferation, segmental sclerosis, and interstitial fibrosis. The association between CFH deposition in renal tissue and serum CFH deposition was not significant. Kaplan-Meier analysis found that the progression-free time was significantly shorter in patients with positive CFH deposition than in patients without CFH deposition [(59.90±1.87) months vs (65.10±1.78) months, P=0.01]. Multivariate Cox regression analysis showed that CFH deposition was still an independent risk factor for IgAN progression after adjustment of baseline eGFR, hemoglobin, systolic blood pressure, and serum albumin (HR=2.54, 95% CI: 1.04-6.17). Conclusion · Patients with positive CFH deposition have severer clinical manifestations and poorer prognosis as compared with patients without CFH deposition, suggesting the local activation of alternative complement pathway rather than systemic activation can promote the progression of IgAN. Related Articles | Metrics

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FSA analysis of the effects of clavicular hook plate on the three-dimensional instantaneous motion of shoulder joints LI Yu, LIU Zhi-yuan, WANG Jin-wu, HU Zhi-gang, DAI Ke-rong 2016, 36 (08):  1150.  doi: 10.3969/j.issn.1674-8115.2016.08.008 Abstract ( 850 )   PDF (4791KB) ( 1515 )   Objective · To explore the effects of clavicular hook plate on the three-dimensional instantaneous motion of shoulder joints after clavicular fracture operation. Methods · Three patients with clavicle fracture who underwent clavicular hook plate fixation were enrolled. A flat type fluoroscopic imaging system and spiral CT were used and a 3D reconstruction model of the clavicle and hook plate was built via thin layer CT. The local coordinate system was established according to anatomical landmarks of the clavicle. The clavicular hook plate and the local coordinate system were matched on X ray images of the clavicle at different postures captured by the fluoroscopic imaging system. The 3D motion resulted from the interaction of the clavicular hook plate and the clavicle under physiological load was simulated by the computer. The displacement and rotation values of the clavicular hook plate and the clavicle at three axis directions were measured for different postures according to the 3D coordinate system established based on the plate and the clavicle. The effects of clavicular hook plate on the motion of shoulder joints after fracture healing were analyzed. Results · The clavicular hook plate affected both abduction, intorsion and extorsion of shoulder joints. In this study, the clavicular hook plate and the clavicle had a rotation angle similar to the rotation angle of the clavicle in normal people (27°) and a larger forward displacement (average 6.8 mm) of distal clavicle as compared with normal people (5.1 mm). The average abduction angle in patients was 84.79°. Conclusion · Patients with the clavicular hook plate should remove the internal fixation timely 3-6 months after surgery in order to avoid the subacromial impingement syndrome. Related Articles | Metrics

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Number of regulatory B cells in peripheral blood in pemphigus patients and its clinical significance XU Ren-chao, PAN Meng 2016, 36 (08):  1154.  doi: 10.3969/j.issn.1674-8115.2016.08.009 Abstract ( 930 )   PDF (7762KB) ( 956 )   Objective · To explore the number of regulatory B cells in peripheral blood in patients with pemphigus and its significance in the incidence of pemphigus. Methods · Peripheral venous blood specimens were collected from 40 patients with pemphigus and 20 healthy controls. Flow cytometry was conducted to measure the number of CD19+IL-10+ B cells after stimulation for 5 and 48 h and the number of CD19+ B cells in peripheral blood. The serum anti-dsg1 antibody and anti-dsg3 antibody titers were measured with ELISA. Results · The difference in the proportion of CD19+ B cells in peripheral blood between pemphigus patients and healthy controls was not statistically significant (P>0.05). There was no significant difference in CD19+ B cells in pemphigus patients at acute onset, chronic active and remittent stages (P>0.05). The number of CD19+IL-10+B cells was significantly higher in pemphigus patients than in healthy controls 5 h after in vitro stimulation (P=0.008). However, the difference between two groups was not statistically significant 48 h after stimulation (P<0.05). In 20 PV patients, the anti-dsg3 antibody titers were significantly higher in patients at acute onset and chronic active stages than in patients at remittent stage (P>0.05). In 20 PF patients, the anti-dsg1 antibody titers were significantly higher in patients at acute onset and chronic active stages than patients in remittent stage (P<0.05). Conclusion · The pathogenic antibody titers in pemphigus patients are not associated with the number of B cells but are associated with disease activity. The function of regulatory B cells in peripheral blood in pemphigus patients may have defects. Related Articles | Metrics

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Negative pressure wound therapy promotes wound healing by alleviating inflammatory reaction in patients with diabetic feet WANG Tao, ZHAO Jun, YU Min, YANG Wen-chao1, JIANG Yu-jie, HE Rui, LIU Fang, JIA Wei-ping 2016, 36 (08):  1159.  doi: 10.3969/j.issn.1674-8115.2016.08.010 Abstract ( 1107 )   PDF (7156KB) ( 1167 )   Objective · To apply the negative pressure wound therapy (NPWT) to the wounds in patients with diabetic feet and observe the effect of NPWT on inflammatory reaction. Methods · Twenty-two patients with diabetic feet were enrolled and randomly assigned to two groups, i.e. the experimental group (n=11) treated with NPWT and debridement regiment and the control group (n=11) treated with debridement regiment alone. Wound tissue samples were collected 0, 7, and 14 d after therapy and the hematoxylin staining was performed to observe the inflammatory reaction. IL-6 and TNF-α levels were measured with immunohistochemistry and changes in levels of iNOS and COX-2 proteins were detected with ELISA. Results · The inflammatory response was milder in the experimental group than in the control group 7 and 14 d after therapy. Results of immunohistochemistry suggested that the areas of TNF-α positive regions were smaller in the experimental group than in the control group 7 d after therapy [(619.5±15.7) μm2 vs (636.1±14.1) μm2, t=2.597, P=0.017]. The areas of IL-6 positive regions were smaller in the experimental group than in the control group 7 and 14 d after therapy [(626.0±11.5) μm2 vs (664.6±18.8) μm2, t=5.810, P=0.000; (611.4±19.2) μm2 vs (642.1±22.5) μm2, t=3.447, P=0.003]. The results of ELISA showed that the levels of iNOS protein were significantly lower in the experimental group than in the control group 7 and 14 d after therapy [(367.0±24.9) pg/mL vs (404.6±29.9) pg/mL, t=3.206, P=0.004; (241.8±24.1) pg/ml vs (356.7±41.9) pg/mL, t=7.882, P=0.000]. The levels of COX-2 protein were significantly lower in the experimental group than in the control group 7 d after therapy [(622.1±52.4) pg/mL vs (725.1±15.4) pg/mL, t=6.256, P=0.000], as well as 14 d after therapy [(554.3±25.7) pg/mL vs (639.2±50.8) pg/mL, t=4.945, P=0.000]. Conclusion · Inhibition of inflammatory reaction in wounds is one of mechanisms that NPWT can promote the ulcer healing in patients with diabetic feet. Related Articles | Metrics

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Analysis of genotypes and clinical manifestations of three cases of Sotos syndrome KANG Lu-lu, LIU Xiao-qing, ZHANG Hui-wen, QIU Wen-juan, SUN Yu, GU Xue-fan 2016, 36 (08):  1165.  doi: 10.3969/j.issn.1674-8115.2016.08.011 Abstract ( 2261 )   PDF (8128KB) ( 1524 )   Objective · To investigate the clinical and genetic characteristics of Sotos syndrome and improve the awareness of this disorder among Chinese population. Methods · Clinical characteristics and gene sequencing results of three sporadic cases of Sotos syndrome were retrospectively reviewed. Results · Three male pediatric patients aged from 6 to 11 months were from unrelated families. The first symptom of all three patients was mental retardation. Two of them showed characterized facial appearance, including macrocephaly, broad forehead, down-slanting palpebral fissures, pointed chin, high palate, and bitemporal hair sparsity. One patient had normal facial appearance. Gene sequencing found that all patients carried a heterozygous pathogenic mutation in NSD1 gene with different mutation sites. The c.4118_4119insTGACCTT (L1373F fs*18) was a novel mutation, while c.5885T>C (p.Ile1962Thr) and c.5990A>G (p.Tyr1997Cys) had been reported. The Sotos syndrome was confirmed in 3 patients. Conclusion · Typical symptoms can help diagnose the Sotos syndrome and genetic diagnoses such as DNA sequencing can confirm this disease. Genotypes are associated with phenotypes in Satos syndrome. Related Articles | Metrics

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Analysis of the possible risk factors of gestational diabetes mellitus LUO Ming-juan, HU Yuan-yuan, WU Xue-qin, GU Jian-fen, LIANG Wei, CHIN Robert, LUO Qiong, HUANG Xiao-qing, HU Cheng 2016, 36 (08):  1171.  doi: 10.3969/j.issn.1674-8115.2016.08.012 Abstract ( 915 )   PDF (3101KB) ( 1455 )   Objective · To explore the risk factors for gestational diabetes mellitus (GDM) in Shenzhen. Methods · Four hundred and thirty-two GDM pregnant women and 409 pregnant women with normal glucose tolerance (NGT) who delivered from February 2014 to July 2015 in two hospitals in Shenzhen were enrolled. The data of pregnant women were collected. FBG and HbA1c in the first trimester and OGTT during 24-28 weeks’ gestation were tested. Logistic regression analysis was used to analyze the risk factors for GDM. Results · The age, pre-pregnant body weight and pre-pregnant BMI were higher in the GDM group than in the NGT group (P=0.000 for all). The differences in body weight and BMI before delivery between two groups were not statistically significant. The univariate Logistic regression analysis showed that there were statistical differences in GDM history, pre-pregnant overweight (BMI≥25 kg/m2), diabetes family history, and age≥35 years between two groups. The multivariate Logistic regression analysis indicated that GDM history, pre-pregnant overweight, diabetes family history, and age≥35 years were risk factors for GDM (P<0.05 for all). Conclusion · GDM history, pre-pregnant overweight, diabetes family history, and age≥35 years are the risk factors for GDM. Related Articles | Metrics

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Application of superficial circumflex iliac artery perforator flap in reconstruction after radical surgery of oral cancer HE Yue, JIN Shu-fang, FANG Zao, TIAN Zhuo-wei, QIU Wei-liu, ZHANG Yi-xin, FENG Shao-qing, TAO Xiao-feng, ZHOU Hui-hong, ZHANG Zhi-yuan 2016, 36 (08):  1175.  doi: 10.3969/j.issn.1674-8115.2016.08.013 Abstract ( 818 )   PDF (33199KB) ( 1275 )   Objective · To investigate the anatomic and imaging characteristics of superficial circumflex iliac artery perforator (SCIP) flap and its clinical application in reconstruction after radical surgery of oral cancer. Methods · Fifteen patients underwent the SCIP flap reconstruction after radical surgery of oral cancer. All patients received preoperative examinations with CT angiography, color Doppler ultrasonography and/or MR angiography. The vascular dissection for superficial circumflex iliac artery (SCIA) and defect reconstruction were performed intra-operatively. The function recovery in recipient and donor sites was evaluated postoperatively. Patients were followed up for 2-10 months. Results · The average area and thickness of dissected flaps were (46 ± 22) cm2 and (1.2 ± 0.3) cm, respectively. The relationship between SCIA, deep circumflex iliac artery (DCIA), and superficial inferior epigastric artery (SIEA) could be classified into type 1 (8/15), type 2 (2/15), type 3 (2/15), type 4 (2/15), and type 5 (1/15). Good aesthetic outcome was obtained after surgery in the recipient sites and mouth-open width, speech, and mastication function recovered well. Conclusion · The SCIP flap is a pliable flap with long vascular pedicles and hidden donor site morbidity and an ideal option for oral maxillofacial defect reconstruction. Related Articles | Metrics

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Association of morning hypertension with heart rate and heart rate variability GUO Qian-hui, WANG Fei, CHENG Yi-bang, ZHANG Dong-yan, LI Fei-ka, LI Yan 2016, 36 (08):  1181.  doi: 10.3969/j.issn.1674-8115.2016.08.014 Abstract ( 1024 )   PDF (5212KB) ( 1744 )   Objective · To analyze the association of morning hypertension with heart rate and heart rate variability and explore the association between sympathetic activity and morning hypertension. Methods · We recruited outpatients who visited the Department of Hypertension from Nov. 2010 to Jun. 2015 and were suspected of hypertension with no anti-hypertensive treatment. The 24 h ambulatory blood pressure was monitored and time domain and frequency domain indexes of heart rate variability were measured. The morning hypertension was defined as a mean systolic blood pressure of at least 135 mmHg or a mean diastolic blood pressure of at least 85 mmHg within 2 hours after getting up in the morning. Results · Of 596 subjects, 354 (59.4%) had morning hypertension. The Logistic regression analysis showed that the risk of morning hypertension increased with heart rates in sitting and supine positions, increased heart rate within 24 h and low frequency (LF) heart rate variability in supine position (P<0.01). After adjustments for sex, age, body mass index, cigarette smoking, alcohol consumption, fasting blood glucose, and serum total cholesterol, the associations of morning hypertension with 24 h heart rates and LF heart rate variability were still statistically significant (P<0.05). Conclusion · Morning hypertension is associated with increased heart rate and LF heart rate variability, indicating the association between morning hypertension and activated sympathetic system. Related Articles | Metrics

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Clinical and prognostic analyses of non-Hodgkin lymphoma combined with hemophagocytic syndrome XIAO Hui-fang, HAO Jie, ZHAO Wei-li, WANG li 2016, 36 (08):  1187.  doi: 10.3969/j.issn.1674-8115.2016.08.015 Abstract ( 834 )   PDF (3279KB) ( 1560 )   Objective · To compare the clinical features and prognosis between non-Hodgkin lymphoma (NHL) patients with and without hemophagocytic syndrome (HPS). Methods · A retrospective analysis was performed for 33 NHL patients with HPS (the HPS group) and 76 NHL patients without HPS (the control group) admitted from January 2006 to May 2014. Survival analysis was conducted with Kaplan-Meier method and univariate and multivariate analyses were carried out by using a COX regression model for factors that might affect the survival of patients. Results · The NHL patients with HPS were likely to start with fever. Most bone marrow samples (29/33) had elevated serum ferritin, triglyceride, total bilirubin, and lactate dehydrogenase (LDH) and hemophagocytes could be found in these samples. The NHL patients with HPS had late disease stage, poor physical ability, and severe disease status and their prognosis was poorer compared with controls (P=0.000). Failure to achieve complete remission and the combination of HPS were independent risk factors for poor prognosis of NHL patients. Conclusion · The NHL patients with HPS have severe disease status and poor prognosis. Related Articles | Metrics

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Analysis of risk factors for attention deficit/hyperactivity disorder in pupils LIU Xin, JI Yi-ting, LI Sheng-hui, JIANG Fan, Shen Xiao-ming, MA Jun, LI Fei 2016, 36 (08):  1191.  doi: 10.3969/j.issn.1674-8115.2016.08.016 Abstract ( 738 )   PDF (3146KB) ( 1399 )   Objective · To explore the prevalence of attention-deficit/hyperactivity disorder (ADHD) in different grades of pupils and analyze the risk factors for ADHD in school-aged children. Methods · The diagnosis history of ADHD and general information of children in nine cities such as Shanghai, Guangzhou, Xi’an, etc. were collected from their parents by questionnaires with the use of cluster-stratified method. Six grades in primary schools were assigned to 3 groups, i.e. the grade 1 and 2 group, grade 3 and 4 group, and grade 5 and 6 group. Prevalence of ADHD in 3 groups and differences in study pressure between children with and without ADHD and in prevalence of ADHD between children with different enrollment ages were calculated. Risk factors related to the prevalence of ADHD were analyzed by Logistic regression model. Results · The difference in the prevalence of ADHD between three groups were statistically significant (P<0.05). The prevalence of ADHD in the grade 3 and 4 group was the highest (5.2%). Grade 3 and 4, earlier school enrollment, and study pressure were risk factors for the prevalence of ADHD after adjustment of sex, education of parents, delivery method, etc. Conclusion · Grade 3 and 4, earlier school enrollment (<6 years of age), and study pressure increase the risk of ADH in pupils. Related Articles | Metrics

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Value of monitoring N20 somatosensory evoked potentials for predicting the prognosis of coma patients with traumatic brain injury SONG He-bao, GAO Guo-yi, FENG Jun-feng, LI Yong-tao, Lü Shou-hua, MAO Qing, JIANG Ji-yao 2016, 36 (08):  1196.  doi: 10.3969/j.issn.1674-8115.2016.08.017 Abstract ( 1111 )   PDF (3429KB) ( 1339 )   Objective · To explore the value of continuous monitoring of N20 somatosensory evoked potentials for predicting the prognosis of coma patients with traumatic brain injury. Methods · N20 evoked potential data from 35 patients with severe traumatic brain injury whose Glasgow Coma Scale (GCS) scores were ≤8 points were collected. Continuous monitoring was performed with changes in amplitude and prolonged latency of N20 evoked potential as major monitoring indexes. Apart from routine regular monitoring, monitoring was also performed after emergency hematoma removal, before changes in GCS scores, and before and after hydrocephalus shunt surgery and lumbar puncture procedure. Observation and analysis were conducted in conjunction with patient's conditions. Results · The presence of the amplitude of N20 evoked potential and prolonged latency were closely related to patient's conditions. The prognosis of patients with presence of bilateral N20 was favorable. Conditions of patients with presence of unilateral N20 were relatively stable for a long period of time. The prognosis of patients with absence of bilateral N20 was poor. Conclusion · The amplitude and latency of somatosensory evoked potential N20 provide an objective and simple monitoring method for coma patients with traumatic brain injury during neurological intensive care, as well as prognosis analysis in conjunction with intervention measures. Related Articles | Metrics

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Comparison of clinical efficacy between one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants JIANG Da-peng, ZHAO Xiao, GENG Hong-quan, XU Mao-sheng, JIN Long-hu, XU Guo-feng, LIN Hou-wei, FANG Xiao-liang, HE Lei 2016, 36 (08):  1201.  doi: 10.3969/j.issn.1674-8115.2016.08.018 Abstract ( 987 )   PDF (3012KB) ( 1446 )   Objective · To investigate the clinical efficacy of one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants younger than 3 months. Methods · Clinical data of severe hydronephrosis infants younger than 3 months who underwent pyeloplasty at Xinhua Hospital affiliated to the Shanghai Jiao Tong University School of Medicine from Jan. 2012 to Jul. 2015 were retrospectively analyzed. Twenty-five patients received second-stage pyeloplasty after nephrostomy (the A group) and 39 patients received one-stage pyeloplasty (the B group). The operative time, intraoperative blood loss, incidence rate of complications, hospital stay, and postoperative recovery were compared between two groups. Results · Sixty-four severe hydronephrosis infants younger than 3 months were enrolled. The A group has longer operative time and hospital stay and higher incidence rate of postoperative urinary tract infection as compared with the B group [(81 ± 20) min vs (53 ± 18) min, (11.6 ± 2.6) dvs (6.2 ± 1.5) d, and 36.0% vs 17.9%), respectively]. The hydronephrosis and renal function in two groups were significantly improved 6 months after surgery and the difference between two groups was not statistically significant. Conclusion · Second-stage pyeloplasty after nephrostomy has no obvious advantage for the treatment of severe hydronephrosis in infants younger than 3 months with respect to the final morphology and function recovery of involved kidneys. One-stage pyeloplasty is safe and effective and should be served as the preferred method for the treatment of severe hydronephrosis in infants. Related Articles | Metrics

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A report on 8 cases of total elbow arthroplasty with customized constrained elbow prosthesis HE Fang-zhou, ZHANG Wei-bin, SHEN Yu-hui 2016, 36 (08):  1205.  doi: 10.3969/j.issn.1674-8115.2016.08.019 Abstract ( 919 )   PDF (4022KB) ( 1435 )   Objective · To evaluate the early stage postoperative clinical efficacy of total elbow arthroplasty with customized constrained elbow prosthesis for the treatment of refractory destructive elbow diseases and analyze technical essentials of the operation. Methods · From Dec. 2009 to Jun. 2015, eight patients with refractory destructive elbow diseases underwent the total elbow arthroplasty with customized constrained elbow prosthesis (histiocytosarcoma with pathological fracture, malignant peripheral nerve sheath tumor, giant cell tumor, fibrous dysplasia, fibrous dysplasia with secondary aneurysmal bone cyst, villonodular synovitis, chronic synovitis, and hemophilic arthropathy with pathological fracture, one each). Preoperative Mayo Elbow Performance Index scores were <60 points in 6 patients, 60-74 points in 1 patient, and 75-89 points in 1 patient. The elbow posterior approach and ulnar nerve subcutaneous anterior transposition were performed and all patients achieved normal extension and flexion after arthroplasty. The extension and flexion exercise began 2 weeks after operation. The clinical efficacy and radiographic changes were evaluated. Results · The immediate postoperative radiographic evaluation showed no prosthesis handle pull-through failure, proper bone cement, stable prostheses, no infection, and no vessel and radial nerve injuries. The cubital nerve numb was seen in one patient and recovered after 2 weeks. This patient also had elbow instability after operation. The average follow-up period was 21.6 months. Mayo Elbow Performance Index scores during follow-up were 60-74 points in 1 patient, 75-89 points in 2 patients, and >90 in 5 patients. The radiographic evaluation showed that all prostheses were in position without looseness or fracture. The subjective satisfaction of patients was high. Conclusion · The total elbow arthroplasty with customized constrained elbow prosthesis is a reliable approach to treat refractory destructive elbow diseases. The technical essentials are ulnar and radius nerve protection, total resection of lesions, and ulnar prosthesis design. The prosthesis installation skill is a key point for avoiding complications. Related Articles | Metrics

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Research advances in ESAT-6 secretion system in Staphylococcus aureus WANG Ya-nan, LI Min 2016, 36 (08):  1210.  doi: 10.3969/j.issn.1674-8115.2016.08.020 Abstract ( 1144 )   PDF (4181KB) ( 1644 )   Staphylococcus aureus is an important opportunistic pathogen that causes a variety of infections, which can involve all organs in the body and seriously threat people’s health. The ESAT-6 secretion system widely exists in gram-positive bacteria. Typical ESAT-6 pathway is composed of a gene cluster consisting of esxA, esxB, and nine other molecules in Staphylococcus aureus. ESAT-6/WXG100 protein family secreted by this system plays a critical role in virulence and protective immunity of Staphylococcus aureus. This article reviews research advances in ESAT-6 secretion system in Staphylococcus aureus. Related Articles | Metrics

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Clinical research progresses of miRNAs in acute coronary syndrome CAO Hui-min, XUE Xiao-mei, YOU Sha-sha, HE Bin 2016, 36 (08):  1215.  doi: 10.3969/j.issn.1674-8115.2016.08.021 Abstract ( 745 )   PDF (6439KB) ( 1471 )   The morbidity and mortality of acute coronary syndrome (ACS) are gradually increasing. Gene therapy has become a hot spot in clinical research and microRNAs (miRNAs) are novel target genes with a promising future in clinical application. For ACS, the expressions of cardiac-specific miRNAs will change in both tissues and blood such as miR-1, miR-133, miR-208, and miR-499, which may be ideal new biomarkers for early diagnosis and predicting the prognosis of ACS. miR-499 and miR-208 are particularly prospective because they only express in myocardium with high specificity. Meanwhile, miRNAs may also serve as targets of new cardiovascular drugs, which can slow down the disease progression and alleviate some symptoms via over-expressions or suppression of expressions of related miRNAs. This article reviews clinical research progresses of microRNAs in ACS. Related Articles | Metrics

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Role of protein post-translational modifications of lysine in tumor glucose metabolism WANG Yun-qian, CHEN Ying-xuan 2016, 36 (08):  1219.  doi: 10.3969/j.issn.1674-8115.2016.08.022 Abstract ( 1000 )   PDF (3066KB) ( 1833 )   Although reprogramming of cancer glucose metabolism has attracted more and more attention, the underlying mechanism is not clear. Proteomic studies revealed that post-translational modifications (PTMs) of lysine residues exist in numerous cytoplasmic and mitochondrial proteins, suggesting they play a critical role in metabolic regulation. The present review summarizes the role of protein PTMs of lysine in the regulation of tumor glucose metabolism and further elucidates the association between PTMs and the regulation of tumor glucose metabolism, which may provide novel approaches to tumor treatment. Related Articles | Metrics

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Molecular typing of acute myeloid leukemia WANG Shu, CHEN Bing 2016, 36 (08):  1223.  doi: 10.3969/j.issn.1674-8115.2016.08.023 Abstract ( 1717 )   PDF (5282KB) ( 2295 )   Acute myeloid leukemia (AML) is a malignant clonal disease originating from hemopoietic stem cells or progenitor cells. The occurrence and development of AML involve various genetic abnormalities. Accurate diagnostic typing is an important basis for clinical treatment and prognosis evaluation of AML. With the in-depth research on the pathogenesis of AML and progresses of cytogenetics, molecular biology, and high throughput sequencing, the development of typing and prognosis evaluation system for AML has been successively based on cytomorphology, cytogenetics, and molecular typing. The molecular typing system provides essential reference for accurate typing, individualized stratified therapy, prognosis evaluation, and efficacy monitoring, etc. and lays a solid foundation for modern accurate diagnosis and treatment of AML. Related Articles | Metrics

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#br# Omega-3 fatty acids and cardiovascular diseases CHENG Di, LIN Lin, DU Rui, LU Jie-li 2016, 36 (08):  1231.  doi: 10.3969/j.issn.1674-8115.2016.08.024 Abstract ( 1286 )   PDF (3394KB) ( 1725 )   Omega-3 polyunsaturated fatty acids are essential fatty acids that cannot be synthesized in human body. The effects of omega-3 fatty acids are closely associated with the bioactivity of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Considerable research suggested that omega-3 fatty acids can improve the cardiovascular diseases. However, some studies obtained conflictive results in recent years. This article reviews major dietary sources and synthesis pathways of omega-3 fatty acids and discusses their effects on cardiovascular risk factors, the clinical evidence of cardiovascular protective effect, as well as mechanisms. Related Articles | Metrics

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Utilization of the zebrafish model for studying the role of hypoxic stress in hematopoiesis and hematopoietic diseases ZHANG Fan, HUANG Qiu-hua, CHEN Sai-juan, SUN Xiao-jian 2016, 36 (08):  1237.  doi: 10.3969/j.issn.1674-8115.2016.08.025 Abstract ( 1104 )   PDF (3199KB) ( 1747 )   Zebrafish, an ideal animal model for studying human hematopoiesis and hematopoietic diseases, has been widely used to study occurrence and migration of hematopoietic stem cell (HSC), interaction between HSCs and microenvironment, as well as pathogenesis of hematopoietic diseases. Recent studies revealed that the hypoxic stress signaling pathway plays an essential role in in vivo development and in vitro culture and expansion of HSCs. The key factors in this signaling pathway and the mechanisms of regulating downstream target genes are considerably conserved between human and zebrafish. As a complement to mouse models, zebrafish presents some distinct advantages for studies on this area. Utilization of the zebrafish model for studying the role of hypoxic stress in hematopoiesis and hematopoietic diseases should be helpful for further understanding the mechanisms of hematopoiesis and the occurrence of hematopoietic diseases and provide novel ideas for the treatment of hematopoietic diseases. Related Articles | Metrics

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An update about role of ovarian cancer-associated fibroblasts BU Shi-xia, LAI Dong-mei 2016, 36 (08):  1242.  doi: 10.3969/j.issn.1674-8115.2016.08.026 Abstract ( 1227 )   PDF (3250KB) ( 1396 )   Epithelial ovarian cancer (EOC) remains the leading cause of gynecological cancer-related death. In the tumor microenvironment, the reciprocal inter-communication between ovarian cancer cells and ovarian cancer-associated fibroblasts (OCAFs) plays an important role in the progression of ovarian cancer. This review discusses the latest research progresses about OCAFs, including their possible origins, their effects on the progression of ovarian cancer, the potential diagnostic and predictive value of OCAFs, and the potential of OCAF-targeted therapy. Related Articles | Metrics

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Research progresses of routine blood parameters in patients with sudden sensorineural hearing loss XIA Liang, GUO Yang, SUN Yuan-yuan, FENG Yan-mei 2016, 36 (08):  1246.  doi: 10.3969/j.issn.1674-8115.2016.08.027 Abstract ( 975 )   PDF (3072KB) ( 1426 )   Sudden sensorineural hearing loss (SSHL) is a common otological disease. The prevalence of SSHL is increasing in China. There are many hypotheses about the etiology and pathology of SSHL, but the pathogenesis of SSHL is not clear. The progress and prognosis of SSHL are associated with many factors. Researchers have tried to assess the progress and prognosis of SSHL through blood routine tests in recent years. This article reviews research progresses of changes in routine blood parameters in patients with SSHL. Related Articles | Metrics

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Research progresses of the association between gut microbiome and polycystic ovary syndrome XU Jie-ying, CHEN Zi-jiang, DU Yan-zhi 2016, 36 (08):  1250.  doi: 10.3969/j.issn.1674-8115.2016.08.028 Abstract ( 1231 )   PDF (3319KB) ( 2051 )   Currently the prevalence of infertility among couples at childbearing age is on the rise in China with the average prevalence of 12.5%-15%, which is gradually becoming an important issue affecting the development of society. The polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women at childbearing age. Studies on female reproductive disorders always focus on PCOS, which is an important cause of infertility. The etiology of PCOS is complex and the pathogenesis is still unclear. As a complex endocrine metabolic syndrome, PCOS is closely associated with insulin resistance, chronic inflammation, and metabolic syndrome. The pathogenesis and pathological process of PCOS are correlated to the changes of gut microbiome. This paper reviews the research progresses of possible mechanisms of gut microbiome in the occurrence and development of PCOS. Related Articles | Metrics

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Research progresses of SREBP in tumors MIN Xue-jie, ZHAO Li, ZHAO Xiao-ping 2016, 36 (08):  1256.  doi: 10.3969/j.issn.1674-8115.2016.08.029 Abstract ( 1685 )   PDF (2954KB) ( 3387 )   Lipid metabolism is one of three major metabolisms and plays an important physiological role in energy storage and supply, maintaining the structure of cell membrane, comprising plasma lipoproteins, and signal transduction, etc. Sterol regulatory element-binding protein (SREBP) are a family of nuclear transcription factors that regulate lipid metabolism in eukaryotic cells. Newly synthesized inactive SREBP are activated via two proteolytic processes and translocate into nucleus to activate the transcription of target genes. SREBP regulate the synthesis of cholesterol and fatty acid by regulating the transcription of genes relevant to fatty acid synthase (FASN), acetyl CoA carboxylase (ACC), and stearyl acyl coenzyme A desaturation enzyme (SCD1), etc. However, the regulation of SREBP in tumors is often abnormal. This article reviews structures and functions of SREBP, as well as the association between SREBP and tumors. Related Articles | Metrics