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Table of Content
18 April 2019, Volume 51 Issue 2
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  • Chronic phosphoproteomic in temporal lobe epilepsy mouse models induced by kainic acid
    Zhi-ming SUN,Qian CHEN,Ming-hua LI,Wei-ning MA,Xu-yang ZHAO,Zhuo HUANG
    2019, (2):  197-205.  doi: 10.19723/j.issn.1671-167X.2019.02.001    
    Abstract ( 1081 )   HTML ( 38 )   PDF (3758KB) ( 342 )   Save
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    Objective: To investigate functions of proteins and signaling pathways involved in epileptogenesis during the chronic stage of temporal lobe epilepsy in mouse models.Methods: Kainic acid-induced temporal lobe epilepsy models were conducted, when reaching stage 4 using racine scale, the mice of experimental group were supposed to be successfully established. Pentobarbital sodium was injected to stop epileptic seizure in case of death. Twenty-eight days after the kainic acid injection, when the experimental group generally turned into chronic spontaneous seizures, mice hippocampal tissues were extracted from the control and the experimental groups respectively for phosphoproteomic. Enriched phosphorylated proteins were detected using mass spectrometry, only the proteins whose density was greater than 10 6 were analyzed by matching the Gene Ontology (GO) database, Kyoto Encyclopedia of Genes and Genomes (KEGG) database and STRING database to detect proteins involved in epileptogenesis in protein functions, signaling pathways and protein-protein interaction respectively. After that, literatures were reviewed about the key proteins.Results: (1) Total of 12 697 phosphorylation sites of enriched proteins were detected by mass spectrometry, and there were 159 sites whose phosphorylation levels were significantly different from the control (P<0.001). (2) GO database showed that 35.7% of the 159 sites were about “catalytic activity”, 39.5% were about “binding” and 20.8% were about “cell communication”, and the 159 proteins also participated in many biological processes, such as “primary metabolic process” “response to stimulus” “developmental process” “localization” and “phosphate-containing compound metabolic process”. (3) KEGG database showed that the 159 protein sites mainly involved in 10 signaling pathways: glutamatergic synapse, Ras signaling pathway, African trypanosomiasis, Cocaine addiction, Circadian entrainment, Amyotrophic lateral sclerosis (ALS), Long-term potentiation, Endocytosis, Gap junction, Nicotine addiction. (4) STRING database showed that the protein-protein interaction network formed by the 159 proteins was focused on Grin1/Dlg3, Arhgef 2/Arhgap33/Tiam1 and Sptnb1/3/4/Add3/Ank2 protein group respectively. (5) Phosphorylation levels of Grin1, Arhgef 2, Arhgap33, Tiam1, Sptbn1/2/4 and Ank2 in experimental group were significantly higher than in the control (P<0.001).Conclusion: Phosphoproteomic illustrated integral distribution of phosphorylated proteins at the chronic stage of temporal lobe epilepsy in the mouse model. Literatures showed that most key proteins were closely related to epileptogenesis, suggesting that some proteins or signaling pathways may play a role in epileptogenesis, such as dopamine and Kir3.1.

    Temporary acceleration of interstitial fluid drainage in excited brain region induced by movement
    Wei WANG,Jin HOU,Wen-qiang HUANG
    2019, (2):  206-209.  doi: 10.19723/j.issn.1671-167X.2019.02.002    
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    Objective: To investigate the changes of brain interstitial fluid (ISF) induced by movement.Methods: Twenty mature male Sprague-Dawley rats were randomly divided into two groups: control group and movement group. Electrophysiological neurons in caudate nuclear of additional five rats were recorded and the differences analyzed between under anesthesia and by movement. In the control group, the rats were anesthetized using isoflurane continuously during the experiment process. In the meantime the magnetic tracer was injected into the center of the caudate nucleus and multi-period magne-tic resonance scanning was performed at several time points until high signal intensity invisible in the images. In the movement group, the rats were anesthetized for the injection of the tracer, and the first post-injection magnetic resonance scanning was performed. Then the rats were waken and allowed moving voluntarily for 20 minutes. The rats were anesthetized again and multi-period magnetic resonance scanning was performed until the experiment ended. NanoDetect system (Version 1.2, MRI lab, Beijing, China) was used to measure the parameters on ISF, which included the weighed signal intensity (weighed ΔSI) , the term predicting the amount of the tracer, and half-time of the tracer. In movement group, the weighed ΔSI at the time points of pre-movement and 10, 40, 70, 130, and 190 minutes after movement were calculated respectively. In control group, the weighed ΔSI at the same time points also were measured. The weighed ΔSI and half-time were compared between the two groups.Results: The electrophysiological recording and data analysis showed significant difference in the local field potential of Caudate Nucleus between under anesthesia and by movement. The weighed ΔSI (unit: ΔSI×mm 3) va-lues of the two groups, presented by movement group vs. control group, were as followings, 60 257.1±23 069.2 vs. 61 072.0±19 547.3 at pre-move, 83 624.3±21 475.7 vs. 71 218.1±12 586.5 at 10 min after movement, 57 336.0±36 243.4 vs. 69 756.1±13 306.0 at 40 min after movement, 43 705.9±10 246.3 vs. 55 443.2±20 733.3 at 70 min after movement, 7 734.9±2 645.2 vs. 8 967.6±2 007.3 at 130 min after movement and 2 497.3±987.5 vs. 3 013.2±1 760.8 at 190 min after movement. Moreover, at 40 min after movement, the weighed ΔSI of movement group was significantly reduced compared with control group (P<0.05). The half-time was not significantly different [(104.3±54.1) min vs. (113.4±47.3) min, P>0.05]. Conclusion: ISF drainage of caudate nuclear can be acclerated temporarily by movement.

    Novel tumor metastasis suppressorgene LASS2/TMSG1 S248A mutant promotes invasion of prostate cancer cells through increasing ATP6V0C expression
    Kuan-gen ZHANG,Yu-he ZHOU,Ya-kun SHAO,Fang MEI,Jiang-feng YOU,Bei-ying LIU,Fei PEI
    2019, (2):  210-220.  doi: 10.19723/j.issn.1671-167X.2019.02.003    
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    Objective: LASS2/TMSG1 gene is a novel tumor metastasis suppressor gene cloned from human prostate cancer cell line PC-3M in 1999 by Department of Pathology,Peking University of Basic Medical Sciences. It was found out that protein encoded by LASS2/TMSG1 could interact with the c subunit of vacuolar-ATPase (ATP6V0C). In this study, we explored the effect of LASS2/TMSG1 and its mutants on proliferation, migration and invasion of human prostate cancer cells and its molecular mechanism.Methods: We constructed four LASS2/TMSG1 mutants and stably transfected the variants to human prostate cancer cell line PC-3M-1E8 cell with high metastatic potential. The stable transfectants were identified by qPCR and Western blot through analyzing the expression of LASS2/TMSG1 and ATP6V0C, the cell biology functions of LASS2/TMSG1 and its four mutants were studied using growth curve,MTT assay, soft agar colony formation assay, wound migration assay, Matrigel invasion study and flow cytometry. Furthermore, immunofluorescence was used to analysis the interaction of LASS2/ TMSG1 mutants and ATP6V0C.Results: LASS2/TMSG1 mRNA and protein in LASS2/TMSG1 group and Mut1-Mut4 groups were higher than that in Vector group; Western blot showed that ATP6V0C protein in LASS2/TMSG1 wild group was lower than that in Vector group, but ATP6V0C protein in LASS2/TMSG1 S248A group was obviously higher than that in Vector group. MTT test and growth curve assay showed growth ability in LASS2/TMSG1 S248A group was increasing compared with other groups from day 5. Soft Agar colony formation experiment showed anchor independent growth ability in LASS2/TMSG1 S248A group was higher than those in the other groups (P<0.05), Cell migrations (from 35.3%±3.2% to 70.3%±3%) in LASS2/TMSG1 S248A group was increasing compared with LASS2/TMSG1 wild group (P<0.01), and more cells passed through Matrigel in LASS2/TMSG1 S248A group compared with LASS2/TMSG1 wild group (from 50±3.2 to 203±6.5, P<0.01), the apoptosis rate in LASS2/TMSG1 S248A group was obviously higher than that in LASS2/TMSG1 wild group (from 7% to 15.1%, P<0.05), and the G0/G1 ratio in LASS2/TMSG1 S248A group was obviously higher than that in LASS2/TMSG1 wild group (from 51.0% to 85.4%). Furthermore, double immunofluorescent staining observed the colocalization between ATP6V0C and LASS2/TMSG1 protein and its mutations, the expression of ATP6V0C in LASS2/TMSG1 S248A group increased significantly compared with the other groups.Conclusion: LASS2/TMSG1 S248A promotes proliferation, migration and invasion of prostate cancer cells through increasing ATP6V0C expression, suggesting that aa248-250 is an important function site for LASS2/TMSG1 in invasion suppression of prostate cancer cells.

    Role of miR-106b-5p in the regulation of gene profiles in endothelial cells
    Jing ZHANG,Su-fang LI,Hong CHEN,Jun-xian SONG
    2019, (2):  221-227.  doi: 10.19723/j.issn.1671-167X.2019.02.004    
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    Objective: To evaluate the role of miR-106b-5p in the regulation of gene expression in endothelial cells.Methods: The Taqman low-density microRNAs (miRNAs) array (TLDA) was used to identify miRNA expression profiles in the plasma of patients with atherosclerotic coronary artery disease (CAD) (atherosclerosis group, n=9) and individuals without atherosclerotic CAD disease (control group, n=9). A weighed and undirected miRNA coexpression network analysis was performed to investigate the interactions among miRNAs in the two groups. MiR-106b-5p, whose coexpression pattern in atherosclerosis group was most different from that of control group, was further studied. Human umbilical vein endothelial cells (HUVEC) were transfected with miR-106b-5p mimic or negative control mimic, and Affymetrix GeneChip Human Transcriptome Array 2.0 was used to screen the differential gene expression profiles after transfection. And the signal transduction pathway of differential gene profiles was further analyzed in Kyoto Encyclopedia of Genes and Genomes (KEGG) signal pathway database. After parsing the whole KEGG database, all differentially expressed genes involved pathways were extracted, and the hypergeometric distribution was used to calculate the pathway enrichment.Results: The coexpression pattern of the patients with atherosclerosis (140 nodes, 1 154 edges) differed from that of the non-atherosclerosis control group (140 nodes, 612 edges). The analysis of array data with significant analysis of microarray (SAM) identified 746 significantly deregulated genes (fold change ≥ 1.5 and false discovery rate < 0.01) altered by overexpression of miR-106b-5p with miR-106b-5p mimic in HUVEC. By calculating the pathway enrichment, we found that multiple signaling pathways enriched in differential gene profiles were closely related to the process of formation and rupture of atherosclerotic plaque, including phosphatidylinositol-3 kinase (PI3K)/ protein kinase B (PKB, also called Akt), mammalian target of rapamycin (mTOR), transforming growth factor-β (TGF-β), janus kinase / signal transducer and activator of transcription (Jak-STAT), tumor necrosis factor (TNF), toll like receptor (TLR) and hypoxia-inducible factor 1α (HIF-1α) and other signal pathways.Conclusion: The coexpression pattern of miRNAs in plasma of patients with atherosclerosis is more significantly changed than that of individuals without atherosclerotic disease. MiR-106b-5p, which shows the most significant dif-ference between groups, targets multiple signal pathways in vascular endothelial cells, and might play an important role in the regulatory network of atherosclerotic gene expression.

    CMTM2 is involved in spermiogenesis in mice
    Xiao-wei ZHANG,Hua-qi YIN,Qing LI,Yong-ping ZHAO,BRANDES Kite,Wen-jun BAI,Tao XU
    2019, (2):  228-233.  doi: 10.19723/j.issn.1671-167X.2019.02.005    
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    Objective: To investigate whether CKLF-like MARVEL transmembrane domain-containing protein 2 (CMTM2) is involved in spermatogenesis in mice. CMTM2 is highly expressed in testis, and could possibly be a potential spermagogenesis specific gene.Methods: CMTM2-deficient mouse model was generated. Northern, RT-PCR and Western blotting analysis were performed on total RNA derived from wild-type (WT, CMTM2 +/+) and CMTM2 +/- (heterozygote) and CMTM2 -/-(homozygote) mice to examine the CMTM2 level. The number of litters and the number of pups were counted and pregnancy rates calculated. The motility and morphology of the sperm and the histology of testes were analyzed. Se-rum testosterone and FSH concentrations were also measured. Standard t-tests were used and standard error of means were calculated.Results: CMTM2 was highly expressed in a finely regulated pattern in the mouse testis during spermatogenesis. The body weight of adult mice with CMTM2 deficiency was not significantly different from that of wild type mice. No obvious anatomical or behavioral abnormalities were observed. The testis of CMTM2 -/- was smaller than that of CMTM2 +/+ mice. The testis diameter in wild mice and CMTM2 null mice were (11.32±1.21) mm vs. (8.29±1.92) mm (P<0.05), and the weights were (101.63±2.33) mg vs. (85.22±2.84) mg (P<0.05), respectively. Female CMTM2 null mice were fertile, indicating that CMTM2 was not required for female gametogenesis. The CMTM2 -/- mice produced virtually no sperm, and CMTM2 +/- mice sperm count showed a significant decline. In terms of sperm morphorlogy study, more round spermatids could be observed in the heterozygote group, compared with the wild type group; while in the homozygote group, a large amount of round spermatids could be observed because of complete arrest of spermiogenesis. The hormone levels were not significantly different. The CMTM2 -/- male mice were sterile due to a late, complete arrest of spermiogenesis. The organized architecture of the seminiferous epithelium of the seminiferous tubules seen in CMTM2 +/+ mice was lost in CMTM2 -/- mice. Conclusion: This study suggests CMTM2 is not required for embryonic development in the mouse but is essential for spermiogenesis, however, further studies are required for more detailed mechanism study.

    Rasfonin inhibits proliferation and migration of osteosarcoma 143B cells
    Fan ZHANG,Tai-qiang YAN,Wei GUO
    2019, (2):  234-238.  doi: 10.19723/j.issn.1671-167X.2019.02.006    
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    Objective: To investigate the effects of rasfonin,a fungal secondary metabolite, on the proliferation and migration of osteosarcoma 143B cells.Methods: 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium,inner salt (MTS) assay was performed to exa-mine 143B cell viability following treatment of rasfonin. Using dimethyl sulfoxide (DMSO) group as control, cell viability was detected when 143B cells were treated with rasfonin (3 μmol/L and 6 μmol/L) for 12 or 24 hours. The effect of rasfonin on colony forming ability was detected by clone formation assay.143B cells treated with DMSO or rasfonin (3 μmol/L) for one week, and the number of clones formed in the two groups was counted. Wound healing and transwell assay were employed to analyze cell invasion and migration upon rasfonin challenge. The DMSO group was used as control while rasfonin (3 μmol/L) was used for 24 hours. The wound healing rate and the number of invasive cells were compared between the two groups. The intracellular autophagosomes were monitored by transmission electron microscopy when 143B cells were treated with DMSO or rasfonin (3 μmol/L) for 4 hours. The expression of p62, microtubule-associated protein 1 light chain 3 fusion protein (LC3) and poly (ADP-ribose) polymerase-1(PARP-1) in response to rasfonin were detected by immunoblotting assay.Results: Rasfonin reduced the viability of 143B cells in a dose-dependent manner (12 h: F=31.36, P<0.01; 24 h: F=67.07, P<0.01). Rasfonin (3 μmol/L) completely inhibited the clonal formation of 143B cells (P<0.01). The wound healing result revealed that rasfonin significantly decreased migratory ability of 143B cells (33.91%±0.83% vs. 65.11%±0.94%, P<0.01), whereas its treatment significantly reduced the number of 143B cells penetrating through Matrigel-containing basement membrane (21.33±1.45 vs. 49.33±2.40, P<0.01). Compared with the control group, rasfonin markedly increased the number of autophagic vacuoles. The immunoblotting results revealed that rasfonin increased LC3-Ⅱ accumulation and decreased p62 levels. Choloroquine (CQ), an often used autophagic inhibitor, further accumulated rasfonin-induced LC3-Ⅱ. In addition, rasfonin appeared to cause the cleavage of PARP-1.Conclusion: Rasfonin induced autophagy and activated caspase-dependent apoptosis in 143B cells concurring with suppressing the proliferation and migration of the cells; these results provide an experimental basis for rasfonin as a potential therapeutic agent for osteosarcoma.

    Effects of sulfur dioxide on alveolar macrophage apoptosis in acute lung injury induced by limb ischemia/reperfusion in rats
    Yan-rui ZHAO,Yang LIU,Dong WANG,Wen-rui LV,Jun-lin ZHOU
    2019, (2):  239-244.  doi: 10.19723/j.issn.1671-167X.2019.02.007    
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    Objective: To investigate the effect of sulfur dioxide (SO2) on the apoptosis of alveolar macrophage (AM) in lung protection of limb ischemia/reperfusion (I/R) induced acute lung injury (ALI), and to find a new target for the control of inflammatory response.Methods: Twenty pathogen-free, adult male Sprague-Dawley (SD) rats (180-230 g) were used in this study. Five rats were to be used for limb ischemia/reperfusion, then plasma was extracted as ischemia/reperfusion serum stimulation. Fifteen rats were to be used for extracting AM by bronchoalveolar lavage. The AM was isolated and cultured, then the cell count was adjusted to 1×10 6/mL, and randomly divided into the following 4 groups (n=6): control group, I/R group, SO2 group, and I/R+SO2 group. The I/R group was given ischemia/reperfusion serum (500 μg/L) to stimulate 6 h; the SO2 group was given an SO2 donor, Na2SO3/NaHSO3 [(0.54 mmol/kg) / (0.18 mmol/kg)]; and the I/R+SO2 group was given the same ischemia/reperfusion serum and Na2SO3/NaHSO3 at the same time. The level of mitochondrial membrane potential, the state of mitochondrial permeability transition pore (mPTP), the rate of AM apoptosis, the expression of Bcl-2 and Caspase-3 proteins were detected by flow cytometry, microplate reader and Western blotting.Results: Compared with the control group, in the I/R group, the ratio of red to green fluorescence and the absorbance decreased significantly, the percentage of apoptotic cells increased obviously, the apoptotic rate was 43.81%±2.40%, Caspase-3 protein expression increased, Bcl-2 protein expression decreased. While compared with the I/R group, in the I/R+SO2 group, the ratio of red to green fluorescence and the absorbance increased significantly; the apoptotic rate decreased to 37.01%±1.93%, Caspase-3 protein expression decreased, Bcl-2 protein expression increased.Conclusion: Exo-genous SO2 has the effect of accelerating AM apoptosis by stimulating mPTP to open and mitochondrial membrane potential to decrease; besides, exogenous SO2 could stimulate AM to secrete more anti-inflammatory cytokines and less inflammatory cytokines. In conclusion, exogenous SO2 can reduce macrophage apoptosis by inhibiting mitochondrial pathways.

    Pulsed electromagnetic fields stimulating osteogenic differentiation and maturation involves primary cilia-PI3K/AKT pathway
    Qian REN,Jian ZHOU,Ming-gang WANG,Ke-ming CHEN
    2019, (2):  245-251.  doi: 10.19723/j.issn.1671-167X.2019.02.008    
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    Objective: To study whether the pulsed electromagnetic fields (PEMF) promoting rat osteoblasts differentiation and maturation is related to the primary cilia and PI3K/AKT pathway, and to explore the mechanism of PEMF in promoting bone differentiation.Methods: Enzyme solution was used to obtain newborn SD rats calvarial osteoblasts (ROB), which were processed by 50 Hz 0.6 mT PEMF for 0, 0.5, 1, 1.5 and 2 h, detecting PI3K and AKT protein expression and changes in primary cilia length and incidence; with LY294002 blocking PI3K/AKT signaling pathways we observed whether PEMF promoted osteogenic differentiation of ROB was affected; by interfering IFT88 gene expression by RNAi to inhibit primary cilia we observed whether PI3K/AKT signaling pathway and osteogenic differentiation of ROB was affected. Osteogenic differentiation indexes included alkaline phosphatase (ALP) activity, Real-time PCR and Western blot detection of osteogenic related genes of BMP-2, COL-1 and OSX and calcified nodules number, etc.Results: After exposure to PEMF for 0, 0.5, 1, 1.5, and 2 h, the protein expression of PI3K and AKT in ROB were increased significantly (P<0.01) and the primary cilia became longer; and the protein expression of PI3K reached the highest level at 0.5 h, as the treatment time of PEMF increased, the PI3K protein expression decreased. AKT showed higher protein expression at 0.5 h and 1.5 h. After blocking the PI3K/AKT signaling pathway with the PI3K blocker LY294002, PEMF could no longer increase ALP activity and the gene expressions of BMP-2, COL-1, OSX which were osteogenically related. However, PEMF could increase the ALP activity and the osteogenically related gene expression in ROB before blocking. After RNAi interfered the primary cilia, PEMF could no longer increase the protein expression of PI3K, which indicated that PEMF could not activate the PI3K/AKT signaling pathway after primary cilia interfering; secondly, the effect of PEMF on enhancing ALP activity disappeared, it also decrease the gene expressions of BMP-2, COL-1, and OSX, and the ability of increasing the calcification nodule formation also disappeared, indicating that the ability of PEMF to promote osteoblast maturation and mineralization disappeared after primary cilia interference.Conclusion: PEMF activated the PI3K/AKT signaling pathway through primary cilia on the surface of osteoblasts, then promoted bone formation activity and differentiation.

    Association of sleep overlap syndrome with type 2 diabetes in a cross-sectional study
    Jiang XIE,Fei LI
    2019, (2):  252-255.  doi: 10.19723/j.issn.1671-167X.2019.02.009    
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    Objective: Growing evidence indicates that both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) may be related to increased risk of developing metabolic disorder and cardiovascular diseases. However, the association of sleep overlap syndrome (combination of COPD and OSA) with type 2 diabetes is unclear. The aim of this study was to investigate the association between overlap syndrome and prevalence of type 2 diabetes.Methods: In this study, 1 939 patients who completed home sleep test from January 2011 to December 2014 in sleep center of Beijing Anzhen Hospital were retrospectively studied. Sleep events were scored by experienced sleep technicians. COPD were diagnosed according to clinical manifestation and spirometry, while OSA was defined by apnea-hypopnea index ≥15 event/h. All subjects were divided retrospectively into overlap syndrome group (n=1 093), isolated COPD group (n=62), isolated OSA group (n=735), and control group (n=49). The independent association of overlap syndrome with type 2 diabetes prevalence was estimated by using Logistic regression models.Results: Compared with control group and the patients with isolated OSA, the patients with overlap syndrome had significantly higher odds of type 2 diabetes (OR=5.82, 95%CI: 3.23-10.48, P<0.001 and OR=4.35, 95%CI: 2.41-7.88, P<0.001), with significance persisting after adjusting for age, sex, and body mass index as confounding factors (OR=2.69, 95%CI: 1.13-6.52, P=0.026 and OR=3.64, 95%CI: 1.53-8.83, P=0.004). Among those younger than 58 years or female subjects, overlap syndrome had independent association with type 2 diabetes (OR=8.45, 95%CI: 1.46-65.90, P=0.018 and OR=4.39, 95%CI: 1.04-22.50, P=0.044). No significant association was found in the patients ≥58 and male subjects.Conclusion: Sleep overlap syndrome is associated with high prevalence of type 2 diabetes. Further study is needed to verify whether treatment toward overlap syndrome may reduce risk of metabolic disorder, and even decrease long-term risk of complications of diabetes.

    Mechanical thrombectomy treatment in patients with acute ischemic stroke: a single center study
    Zi-chang JIA,Xuan LI,Xiao-gang LI,Xiang-zhu ZENG,Jing-yuan LUAN,Chang-ming WANG,Jin-tao HAN
    2019, (2):  256-259.  doi: 10.19723/j.issn.1671-167X.2019.02.010    
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    Objective: To evaluate the effectiveness and safety of mechanical thrombectomy treatment in patients with acute ischemic stroke (AIS),and to explore influential factors of the clinical prognosis preliminarily.Methods: Clinical data of 26 patients with acute cerebral arterial occlusion treated with mechanical thrombectomy in Peking University Third Hospital from January 2014 to June 2017 were retrospectively collected. The immediate effects of the 26 patients in this group after mechanical thrombectomy treatment were analyzed,The national institutes of health stroke scale (NIHSS) scores between preoperative and at discharge of the 26 patients in this group were compared,and modified Rankin scale (mRS) scores of 90 days post operation were analyzed to assess the prognosis of the 26 patients in this group.Results: (1)In this group, 23 patients (88.5%) achieved vascular recanalization evaluated by thrombolysis in cerebral ischemia scale scores [thrombolysis in cerebral ischemia scale (TICI) scores,3/2b grades were recognized as vascular recanalization],19 patients of them reached TICI grade 3 and 4 atients reached TICI grade 2b. In this group 3 patients (11.5%)encountered symptomatic intracranial hemorrhage,2 patients of them recovered after cerebral hemorrhage absorbed and 1 patient died of massive cerebral hemorrhage. In this group 4 patients (15.4%) died after mechanical thrombectomy treatment,2 patients died of hernia of the brain caused by severe cerebral edema,1 patient died of symptomatic intracranial hemorrhage and 1 patient died of extensive subarachnoid hemorrhage.(2)The assessment of NIHSS scores at discharge(5.3±2.1)showed significantly lower than those preoperatively(12.6±4.2), P<0.01,and in this group 12 patients (46.2%) achieved favourable prognosis ( defined as mRS scores 0-2),6 patients of them reached mRS 0 score,4 patients reached mRS 1 score and 2 patients reached mRS 2 scores.Conclusion: Mechanical thrombectomy with stent retriever contributed to a high rate of vascular recanalization and favourable prognosis,but some patients had poor prognosis,suggesting that we should screen the enrolled patients strictly.

    Cerebral blood flow measurements in patients with comorbid hypertension and depression using 3D arterial spin labeling
    Ying LIU,Xiang-zhu ZENG,Zheng WANG,Han ZHANG,Xi-lin WANG,Hui-shu YUAN
    2019, (2):  260-264.  doi: 10.19723/j.issn.1671-167X.2019.02.011    
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    Objective: To evaluate cerebral blood flow (CBF) in patients with comorbid hypertension in depression using 3D pseudocontinuous arterial spin labeling (3D pcASL) and to compare the dif-ferences of CBF values in depression, hypertension, and comorbid hypertension between depression and healthy control groups. To investigate the correlation between CBF values and degrees of depression.Methods: Sixteen patients with depression (depression group, 3 males and 13 females, age range of 42-72 years old), sixteen patients with hypertension (hypertension group, 3 males and 13 females, age range of 41-68 years old), sixteen patients with comorbid hypertension in depression (comorbidity group, 3 males and 13 females, age range of 45-74 years old), and sixteen healthy controls (control group, 3 males and 13 females, age range of 43-68 years old) were recruited. 3D pcASL sequence was performed by GE 3.0T magnetic resonance scanner and CBF map was generated automatically. Statistical parametric mapping (SPM8) was performed to preprocess the CBF map, which was spatially normalized and smoothed. Comparison of the CBF values among the four groups was conducted by ANOVA. Correlation between the average CBF values in areas of decreased CBF and Hamilton depression scale (HAMD-17) was investigated.Results: The patients with comorbid hypertension in depression demonstrated lower CBF in bilateral superior frontal gyri, middle frontal gyri, inferior frontal gyri, right superior parietal gyrus, right inferior parietal gyrus, right supramarginal gyrus, left caudate nucleus and left insula lobe in comparison with the controls. Compared with control group, CBF values decreased in bilateral frontal lobes, but did not reach statistical significance. There were no significant differences of CBF values between the patients with hypertension and control subjects. Compared with depression, the patients with comorbid hypertension in depression showed lower CBF values in bilateral frontal lobes and right supramarginal gyrus. Compared with hypertension, lower CBF values in left middle frontal gyrus in the patients with comorbid hypertension in depression were shown. Correlation analysis indicated that no correlation between CBF values and scores of HAMD-17 was shown.Conclusion: Although there were no significant decreases of CBF values in patients with depression and hypertension, regional hypoperfusions were observed in patients with comorbid hypertension in depression. Hypertension might play a sy-nergistic action on cerebral hypoperfusion in patients with comorbid hypertension in depression.

    Application of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears
    Cui-ping ZHANG,Pei-pei LIU,Qiang FU,Guan-ying GAO,Li-gang CUI,Yan XU,Jian-quan WANG
    2019, (2):  265-267.  doi: 10.19723/j.issn.1671-167X.2019.02.012    
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    Objective: To explore the clinical application of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears.Methods: This research retrospectively analyzed a total of 38 hips from 36 patients (2 of them were bilateral) whose imaging examination showed acetabular labral well healed but the rehabilitating training was limited due to hip pain after arthroscopie repair of acetabular labral tears in our hospital between June 2015 and May 2017. All the patients underwent ultrasound-guided hip joint drug injection treatment. Through comparing the pain and the function of hip before and after drug injection, the clinical application values of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears were explored. The degree of hip pain was assessed by visual analogue score (VAS), which were scored before and after the injection. The hip function was assessed by the hip range of activity. The SPSS 21.0 statistical software was used for the data analysis. The effective rate of hip injection was calculated, which was defined as: (“excellent” + “good”)/total number of cases×100%. The degree of hip pain was assessed by VAS, which was divided into 0 to 10 points with 0 for no pain and 10 for unbearable severe pain. The function of hip was assessed by the hip range of activity. The therapeutic effect of “excellent” meant no pain or occasional slight pain in the hip, along with Patrick test was negative and hip joint was not limited; the therapeutic effect of “good” meant that the pain was significantly reduced, and the hip’s activity was slightly restricted. “No effect” meant that the pain of hip was not relieved, and the Patrick test was positive.Results: The VAS score of the patient before drug injection was 5.46±1.46, and the VAS score was 2.01±0.53 after drug injection 4 weeks later. The score of the latter was significantly lower than that of the former, and the difference was statistically significant (P<0.05). The hip joint activity after ultrasound-guided hip joint drug injection was significantly improved. The therapeutic effective rate was 84.2%.Conclusion: For patients with hip pain and limitations after arthroscopie repair of acetabular labral tears, ultrasound-guided drug injection can effectively reduce hip pain, improve hip activity, and promote hip functional reconstruction.

    Early functional recovery of direct anterior approach versus anterolateral approach for total hip arthroplasty
    Sen-lei LI,Xian-teng YANG,Xiao-bin TIAN,Li SUN
    2019, (2):  268-272.  doi: 10.19723/j.issn.1671-167X.2019.02.013    
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    Objective: To evaluate the early clinical effects of direct anterior approach (DAA) versus anterolateral approach (ALA) on safety and functional recovery following total hip arthroplasty (THA).Methods: Between January 2015 and May 2016, a randomized clinical trial was performed at Guizhou Provincial People’s Hospital. A total of 50 patients who underwent THA were allocated for either the DAA (n=25) or ALA (n=25). DDA group had 25 patients (25 hips), including 16 males and 9 females, with the mean age of (62±2) years, BMI of (23.26 ±4.95) kg/m 2(range: 19.6 to 29.5), and preoperative Harris score of (33.4 ±15.5) (range: 17.9 to 48.9). Eleven cases were diagnosed as primarily hip osteoarthritis, 4 were developmental dysplasia of the hip (DDH, Crowe 2) and 10 were hip avascular necrosis (AVN, Stages 3 to 4). ALA group had 25 patients (25 hips), including 18 males and 7 females, with the mean age of (59±3) years, BMI of (25.35 ±5.8) kg/m 2(range: 18.2 to 29.8), and preoperative Harris score of (38.6 ± 16.7) (range: 23.1 to 56.5). Ten cases were diagnosed as primarily hip osteoarthritis, 3 were developmental dysplasia of the hip (DDH, Crowe 2) and 12 were hip avascular necrosis (AVN, Stages 3 to 4). Operation time, incision length, intra-operative blood loss and functional recovery of hip postoperatively were compared between the two groups.Results: The surgical incision of both groups were stageⅠhealing. The mean follow-up was 6 months. There was no significant difference regarding operation time, incision length, and intra-operative blood loss between the two groups. However, we also found that there was no significant difference in the Harris score 3 months and 6 months postoperatively. In addition, two patients in ALA group suffered claudication (physical examination: abduction dysfunction of hip). We also found that DAA group resulted in better recovery of abductor strength and gait than ALA group during early follow-up.Conclusion: Both DAA and ALA could obtain good results of early curative effect following THA. Moreover, DAA resulted in better gait than ALA during early follow-up.

    Correlation analysis between rotator cuff tear and the superior migration of humeral head
    Yi-chong ZHANG,Jian-hai CHEN,Yu DANG,Ming YANG,Zhong-guo FU,Dian-ying ZHANG,Pei-xun ZHANG,Bao-guo JIANG
    2019, (2):  273-276.  doi: 10.19723/j.issn.1671-167X.2019.02.014    
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    Objective: To evaluate the association between rotator cuff tear and the proximal migration of humeral head.Methods: In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People’s Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups , and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI.Results: In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071).Conclusion: UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.

    Application of the modified internal fixation method of minimally invasive percuta-neous plate osteosynthesis in treatment of proximal humeral fracture
    Bing-chuan LIU,Zhong-wei YANG,Fang ZHOU,Hong-quan JI,Zhi-shan ZHANG,Yan GUO,Yun TIAN
    2019, (2):  277-282.  doi: 10.19723/j.issn.1671-167X.2019.02.015    
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    Objective: To study the clinical outcomes and characteristics of fracture healing of a modified internal fixation method, which was implemented by placing four and two screws respectively at the proximal and distal end of the locking plate in the minimally invasive percutaneous plate osteosynthesis (MIPPO) for patients with proximal humeral fractures.Methods: Patients in Peking University Third Hospital from February 2010 to December 2016 were brought into this retrospective study. Based on different operation methods, they were divided into minimally invasive (MI) group and non-minimally invasive (non-MI) group, and the patients in MI group were performed with the modified internal fixation. In order to observe the varying efficacy for different fracture types between the two groups, we further investigated the patients with Neer two-part and three-part fracture, respectively. The follow-up parameters included general physical examination, X-ray, visual analogue scale (VAS) and Constant-Murley score.Results: A total of 117 patients with an average age of (61.5±16.2) years met the inclusion criteria, and MI group included 45 patients, non-MI group included 72 patients. According to the Neer classification, there were 46 cases of two-part fracture, 63 cases of three-part fracture and 8 cases of four-part fracture. In MI group, there were 17 males and 28 males with an average age of (62.2±17.1) years, including 18 cases of two-part fracture, 23 cases of three-part fracture and 4 cases of four-part fracture. In non-MI group, there were 27 males and 45 females with an average age of (60.1±17.7) years, including 28 cases of two-part fracture, 40 cases of three-part fracture and 4 cases of four-part fracture. There were no significant differences between the two groups in terms of gender (P=0.975), age (P=0.545) and fracture type (P=0.756). The average hospital-stay in MI group and non-MI group was (2.8±1.1) days and (4.3±1.3) days (P=0.023), the operation time was (67.8±14.9) min and (102.3±34.1) min (P<0.001), the blood loss was (21.3±6.5) mL and (181.5±55.6) mL (P<0.001), the Constant-Murley score was 6.1±0.9 and 6.5±0.8 (P=0.032) one week after surgery, and the Constant-Murley score was 66.1±4.3 and 63.4±4.9 (P=0.006) three months after surgery, MI group had significant advantages in these aspects. In terms of Neer two-part and three-part fracture, the VAS score (5.9±0.8) one week postoperatively and the Constant-Murley score (66.6±3.7) three months postoperatively were significantly superior in MI group (P<0.05). In MI group, delayed fracture healing occurred in 1 case (2.2%) and abduction was restricted in 1 case (2.2%). In non-MI group, delayed fracture healing occurred in 3 cases (4.2%) and abduction was restricted in 2 cases (2.8%). There were no internal fixation complications and humeral head necrosis in both groups.Conclusion: Applying the modified internal fixation in MIPPO to cure proximal humeral fractures is effective clinically with thick callus formation occurring at the fracture site. The fracture can achieve normal healing and the shoulder functions can restore well, indicating the modified surgical method is a good treatment option.

    Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures
    Jian CHEN,Cai-hong ZUO,Cai-yi ZHANG,Ming YANG,Pei-xun ZHANG
    2019, (2):  283-287.  doi: 10.19723/j.issn.1671-167X.2019.02.016    
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    Objective: To explore the effect of cephalomedullary nails for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus zimmer natural nail (ZNN) to provide the data support for clinical perioperative management.Methods: A retrospective study was used to analyze the clinical data of elderly intertrochanteric fractures cases which were treated with PFNA or ZNN fixation from May 2016 to May 2017. In the study, 59 cases were followed up completely, in which 28 cases accepted PFNA, and the other 31 cases accepted ZNN. The operation time, amount of bleeding, fracture healing time, postoperative complication, postoperative radiographic measurement (tip apex distance, TAD) and the last follow-up of hip function score were analyzed.Results: The patients were followed up for 6 to 19 months, with an average (10.8±4.0) months. In PFNA group, the operation time was (62.7±14.2) min, the amount of bleeding was (56.8±20.6) mL, the fracture healing time was (4.6±0.8) months, the postoperative complication was 3.6%, the TAD was (17.7±5.5) mm, and the last follow-up hip function score was 91.8±3.6. In ZNN group, the operation time was (73.6±18.3) min, the amount of bleeding was (68.7±31.6) mL, the fracture healing time was (4.5±0.7) months, the postoperative complication was 3.2%, the TAD was (16.5±4.7) mm, and the last follow-up hip function score was 92.2±3.8. The two groups of comparative experiments were carried out, the operation time of the PFNA group was less than that of the ZNN group (P<0.05). There was no significant difference in the amount of bleeding, fracture healing time, postoperative complication, TAD, postoperative hip score between the two groups (P>0.05).Conclusion: Although group ZNN had significant longer operation time than group PFNA, both implants were useful tools in the treatment of elderly intertrochanteric fractures. The operation of PFNA was simpler,while the design of the anterior bow of ZNN might be more suitable for the patients with a large femoral anterior bow.

    Clinical features of long segmental myelopathy caused by nitrous oxide
    Yun-yun WANG,Ren-bin WANG,Wen HONG,Jin-song JIAO,Dan-tao PENG,Zun-jing LIU,Zhao-hui TIAN,Miao JIN,Ming-rui DONG,Xiao-hui DUAN,Lei LIU,Qing SUN,Shao-jie SUN,Li WANG
    2019, (2):  288-292.  doi: 10.19723/j.issn.1671-167X.2019.02.017    
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    Objective: To analyze the clinical and imaging characteristics of the neurological damage caused by nitrous oxide (N2O).Methods: In the study, 10 patients in the Department of Neurology of China-Japan Friendship Hospital from October 2015 to February 2018 were retrospectively analyzed for the demographic data, the history of inhaled N2O, clinical features, blood examination, electrophysiolo-gical examination, spinal magnetic resonance imaging and therapeutic efficacy profiles.Results: The male-to-female ratio was 4 ∶6 and it presented with an age-of-onset 17-26 years [the average age: (20.80±3.12) years]. The time from inhaled N2O to onset was 1 month to 1 year [the average time: (6.95±4.19) months]. Paralysis in all the patients and numbness in 9 patients were the main clinical features, while positive Lhermitte’s sign in 3 patients, urinary and defecation disturbance in 4 patients were also found. Blood examination indicated anemia in 2 patients, giant cell anemia in 1 case and small cell hypochromic anemia in 1 case. 3 cases had been treated with vitamin B12 in an external hospital, and the other 7 cases had abnormal increase in homocysteine levels. Electrophysiological examinations showed sensory and motor nerve involvement in 9 patients, and motor nerve involvement in 1 patient. The severity of lower extremity lesion was significantly heavier than that of upper extremity. Spinal magnetic resonance imagings showed that long segmental lesions were present in the cervical spinal cord of all the patients, 3 cases with long segmental lesions of the thoracic cord and 2 cases with spinal cord swelling. In 6 cases, the horizontal axis had an “inverted V-type” T2 high signal, 1 case was classified as “cre-scent”, and 3 cases were “eight-shaped”. The symptoms in these 10 cases were alleviated in varying degrees after stopping the inhalation of nitrous oxide, actively supplementing high doses of vitamin B12 and doing early rehabilitation exercises.Conclusion: Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the “inverted V-type”. Treatment with high doses of vitamin B12 is effective.

    Comparison of effectiveness and complications between two different methods of augmentation cystoplasty
    Chen LIANG,Wei-yu ZHANG,Hao HU,Qi WANG,Zhi-wei FANG,Ke-xin XU
    2019, (2):  293-297.  doi: 10.19723/j.issn.1671-167X.2019.02.018    
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    Objective: To compare the effectiveness and complications between enterocystoplasty and small intestinal submucosa (SIS) cystoplasty through follow-ups of patients with augmentation cystoplasty in Peking University People’s Hospital, offering alternative approach for future treatment.Methods: In this study, retrospective analyses were carried out in 10 patients who underwent enterocystoplasty or SIS cystoplasty in Peking University People’s Hospital from November 2011 to December 2016. Clinical data were collected including medical history, surgical procedures, laboratory examinations and complications. And then regular follow-ups were developed. Ten patients were separated into groups of enterocystoplasty (n=6) and SIS cystoplasty (n=4), to compare their outcomes.Results: Ten patients all completed the follow-up interview. Five cases underwent augmentation cystoplasty with sigmoid colon, one with ileum and four with SIS cystoplasty successfully. The mean operative time was (302.0±66.6) min, and blood loss was (167.0±135.0) mL. The outcomes of the group of SIS cystoplasty were better in respects of the time of operation, intestinal function recovery, postoperative hospitalization duration and drainage removal. The average scores of American Urological Association symptom score (AUASS), overactive bladder syndrome score (OABSS), International Consultation on Incontinence questionnaire short form (ICI-Q-SF), and O’Leary-Sant Questionnaire were all improved in two groups. Two cases carried clean intermittent self catheterazion and two used long-term indwelling catheter. There were three patients with dilations of renal pelvises and ureters consistently or during bladder was filling preoperatively, and the situations were not going bad after the operations. The short-term complications included two cases of postoperative infection, one case of mild intestinal obstruction and one case of metabolic acidosis. The long-term complications included one case of ureteroinstestinal anastomosis strictures, three of urinary tract infection and one of long-term metabolic acidosis.Conclusion: Enterocystoplasty and SIS cystoplasty are both effective operations to improve symptoms and protect upper urinary function, with no severe complications. Cystoscopic results showed satisfactory mucosa regeneration after SIS cystoplaty in refractory interstitial cystitis/painful bladder syndrome. But the number of patients included were quite small and the follow-up period was not long enough. Prospective control study of larger number of patients with longer follow-ups are expected to find out the effectiveness and safety of SIS cystoplasty.

    Comprehensive treatment of adrenal cortical carcinoma
    Jian-hua DENG,Han-zhong LI,Zhi-gang JI,Yu-shi ZHANG,Guang-hua LIU
    2019, (2):  298-301.  doi: 10.19723/j.issn.1671-167X.2019.02.019    
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    Objective: To investigate the clinical and functional imaging examination and pathological features of adrenocortical carcinoma (ACC), in order to improve the diagnosis and treatment of ACC.Methods: The clinical data of 93 patients with ACC were analyzed retrospectively. Their diagnosis, surgical treatment and follow-up of mitotane medcine therapy were madeaccording to clinical manifestations, adrenal endocrine function determination, imaging examination characteristics and histopathological results.Results: Among the 93 patients, the age ranged from 11 to 76 years, with a median age of 48 years. The ratio of male to female was 1 ∶1.2. Twenty-four hours urinary free cortisol (UFC) elevated in 86 cases, adrenocorticotropic hormone (ACTH) decreased in 88 cases, blood F rhythm disappeared in 82 cases, and 31 cases of aldosterone increased. Thirty-six cases of sexual hormone increased. Neuron specific enolase (NSE) increased in 27 cases. Insulin-like growth factor-1 (IGF-1) increased in 26 cases. Seventy-six cases of high-dose dexamethasone suppression test (HDDST) and low-dose dexamethasone supression test (LDDST) were not suppressed separately. There were 62 cases of hypertension, and typical Cushing manifestations in 81 cases. Blood glucose elevated in 54 cases. Hypokalemia was in 21 cases and androgen secretion increased in 36 cases. The maximum diameter of the tumor was 3-17 cm, with 6 cases of adrenal central vein, renal vein and inferior vena cava tumor thrombus. The recurrence time was 1.2-5.0 years after operation. Metastasis and recurrence were in 56 cases during the follow-up, lung metastasis in 13 cases, liver metastasis in 17 cases, retroperitoneal lymph node metastasis in 9 cases, lumbar metastasis in 7 cases, ovarian metastasis in 3 cases, abdominal wall and incision implantation in 4 cases. Fifteen cases with distant metastasis. Seventy-seven patients were treated with radical adrenalectomy, and the other patients were treated with renal and adrenal resection on the same side of the kidney. There were 5 cases of adrenal tumor with vena cava tumor thrombus in the removal of the tumor, and the other for the partial resection of the vena cava in 3 cases. Regarding the clinical stage, stage I was in 39 cases, stage Ⅱ in 28 cases, stage Ⅲ in 16 cases and stage Ⅳ in 10 cases. The patients were followed up for 8-69 months, and 43 patients survived more than 5 years.Conclusion: Function imaging combined with clinical features and endocrine hormone levels have important roles in ACC early diagnosis. Radical excision is the only effective treatment. Adjuvant or adjuvant mitotane drug therapy can brused for the treatment of recurrence and metastasis ACC patients,. ACC is a tumor with high malignancy and poor prognosis.

    Characteristics analysis of early gastric cancer under white light endoscopy
    Xin LIU,Jing ZHANG,Ye WANG,He-jun ZHANG,Shi-gang DING,Li-ya Zhou
    2019, (2):  302-306.  doi: 10.19723/j.issn.1671-167X.2019.02.020    
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    Objective: To investigate endoscopic features of early gastric cancer and clinical features of the patients, which may be helpful to provide reasonable suggestions for physicians to diagnose early gastric cancer during preliminary screening of white light gastroscopy.Methods: A total of 271 patients who received endoscopic submucosal dissection or surgical operation to confirm early gastric cancer in Peking University Third Hospital from Apr.2009 to Jun.2017 were included for the retrospective review. Clinical information was collected, including gender, age, symptoms, family history and physical examination. The endoscopic characteristics of lesions under white light endoscopy were analyzed, including endoscopic long diameter, location, texture, spontaneous bleeding, mucosal color and morphology. The pathologic long diameter, infiltration depth and differentiation degree of early gastric cancer were also summarized.Results: The study included 271 patients and 279 lesions. Among the 271 cases, 190 were male, 81 were female, average age was (63.7±12.4) years. There were 88 cases (32.5%) and 61 cases (22.5%) with the symptom of abdominal pain and discomfort respectively. The patients with family history of gastric cancer were 20 (7.4%). Abdominal physical examinations of the patients were mostly normal, accounting for 86.0% (233/271).Total detection rate of helicobacter pylori (HP) was 34.2% (79/231), with the highest rate 45.5% (10/22) in 2011 and the lowest rate 28.1% (9/32) in 2014. Among the 279 lesions, the mean endoscopic long diameter was (2.01±1.20) cm. The lesions were mainly single, accounting for 97.0% (263/271). There were 114 cases (40.9%), 62 cases (22.2%), 54 cases (19.4%) in the antrum, angular sulcus and cardia of stomach respectively. The lesions were mostly fragile, accounting for 45.5% (56/123). Most lesions had spontaneous bleeding, accounting for 52.3% (146/279). The mucosal color was mostly normal, accounting for 72.8% (203/279).The most common macroscopic morphology was Ⅱa+Ⅱc type (100 cases, 35.8%) and the lesions usually had mucous membrane damage like erosion and shallow ulcer(127 cases,45.5%). Among the 279 lesions, the mean pathologic long diameter was (2.05±1.48) cm. Intramucosal carcinoma accounted for 61.6% (172/279) and moderate differentiated gastric cancers accounted for 52.8% (131/248).Conclusion: In order to improve diagnosis of early gastric cancer,superficial elevation and depression of flat lesions as well as mucous membrane damage under white light endoscopy should be taken notice.

    Early effects of low-level long-term occupational chromate exposure on workers’ health
    Jia-xing LIU,Gui-ping HU,Lin ZHAO,Yong-ming ZHANG,Li WANG,Guang JIA,Rui-xiang LIU,Hui-min FENG,Hua-dong XU
    2019, (2):  307-314.  doi: 10.19723/j.issn.1671-167X.2019.02.021    
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    Objective: To explore the effects of low-level long-term occupational exposure to chromate on the health of workers, and the potential biomarkers of early health effects in terms of lung function, immune toxicity and genetic damage.Methods: A total of 22 chromate contact workers and 44 non-chromate contact workers from an electroplating enterprise with long-term occupational environment monitoring in line with the national standards in Inner Mongolia were investigated. The questionnaire survey was conducted to collect the basic situation, the history of smoking, drinking, diseases and so on. The portable lung function instrument, inductively coupled plasma mass spectrometry and cytokinesis-blocked micronucleus test were performed to measure the chromate contact workers’ lung function, whole blood Cr (WB-Cr) and micronuclei frequency (MNF) of peripheral blood lymphocytes respectively. The cytometric bead array was used to detect the levels of IL-1β, IL-6, IL-8, IL-10, IL-12P70 and TNFα in the serum among the two groups. The effects of chromate exposure on the above-mentioned indexes involved biological exposure, lung function, immune response and genetic damage, and their correlation were analyzed with different statistical methods.Results: (1) the average length of service for chromate contact workers was 31 years, and their concentration of WB-Cr was 1.11-4.19 μg/L. They were divided into high and low exposure groups according to the median of 1.72 μg/L. The WB-Cr in the high exposure group (2.17 μg/L) was higher than that in the low exposure group (1.58 μg/L) as well as the reference value of the healthy population (1.74 μg/L, P<0.05); (2) the lung function test showed 10 (45.45%) chromate exposure workers had single or multiple abnormal lung function indexes, among which large airway injury index PEF, and small airway injury indexes MVV and FEF25%-75% were all negatively correlated with WB-Cr (r=-0.53, P<0.05; r=-0.52, P<0.05; r=-0.44, P<0.05); (3) IL-1β, IL-6, IL-8 and TNFα in the serum of chromate contact workers were higher than those in the control group (P<0.05), and there was a positive correlation between TNFα and WB-Cr, and among these cytokines (P<0.05); (4) the average lymphocyte MNF in chromate contact workers was 1.341%, higher than the reference value of the general population (0.436%, P<0.01). Poisson regression analysis showed MNF in thehigh exposure group was higher than that in the low exposure group, OR (95%CI) =1.323 (1.049, 1.669); (5) multiple linear regression analysis showed that the lung function index FEF25%-75% decreased with the increase of TNFα (P<0.05), no significant correlation was found between other cytokines, MNF and lung function indexes.Conclusion: Long-term low-level occupational exposure to chromate can cause the decline of lung function, immune inflammatory reaction and genetic damage in workers, in which local or systemic inflammatory response is associated with decreased lung function. Lung function indexes PEF, FEF25%-75% and MVV, serum cytokines IL-1β, IL-6, IL-8, and TNFα, and peripheral blood lymphocyte MNF may be used as early health effects biomarkers of chromate exposure.

    Effect of different plasma treated zirconia on the adhensive behaviour of human gingival fibroblasts
    Miao ZHENG,Ling-lu ZHAN,Zhi-qiang LIU,He-ping LI,Jian-guo TAN
    2019, (2):  315-320.  doi: 10.19723/j.issn.1671-167X.2019.02.022    
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    Objective: To evaluate the effect of different cold atmospheric plasma (CAP) treatment on the surface chemical and physical properties of zirconia and adhensive behaviour of human gingival fibroblasts (HGFs) cultured on zirconia disks.Methods: The zirconia disks were divided into four groups and treated using helium, argon and mixture of argon and oxygen cold atmospheric plasma for 90 s or left untreated. The surface morphology, wettability and chemical elements were analyzed right after treatment. Human gingival fibroblasts were grown from biopsies obtained from a periodontally healthy human subject during periodontal surgery. HGFs were seeded on zirconia disk, and cells density was measured at the time point of 3 hours. Indirect immunofluorescence (IIF) was performed for morphometric examination at the time point of 3 hours.Results: The crystallographic structure of zirconia was analyzed pre-viously and the results suggested that it fitted the properties of zirconium yttrium oxide. After helium, argon and mixture of argon and oxygen cold atmospheric plasma treatment, the surface morphology and roughness of zirconia disks remained the same. The contact angle of zirconia decreased significantly(P<0.05)after CAP treatment: from 68.38° to 17.90°. After different CAP plasmas treatment, the atomic percentage of carbon on the outermost surface of the three groups decreased, as did the surface C/O ratio. The surface C/O ratio of zirconia decreased from 1.07 to 0.33. Fibroblasts density increased on CAP treated disks, especially the ones treated by mixture of argon and oxygen CAP(P<0.05). Cells of the three CAP plasma treatment groups spread better and had more protrusions, as well as larger surficial areas.Conclusion: Based on the results of this study after being treated by different kinds of CAP plasmas for 90 s, the surface wettability increased and the elements changed significantly with no changes in the tomography and roughness of the materials. The CAP treatment enhances the adhensive behavior of fibroblasts on zirconia by increasing the oxygen functional groups and promoting the cell density. Wettability of zirconia, an important physicochemical property, has a vital influence on the cell behaviors.

    Effect of intrapulpal pressure on the bonding strength of resin cement to dentin
    Yi-xiang PAN,Xiu-hua LI,Fu-cong TIAN,Xiao-yan WANG
    2019, (2):  321-326.  doi: 10.19723/j.issn.1671-167X.2019.02.023    
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    Objective: To evaluate the effect of intrapulpal pressure simulation on the micro-tensile bond strength (μTBS) of resin cement to dentin.Methods: Thirty extracted human third molars were selected. Occlusal enamel was removed to expose dentine surface and teeth with residual dentin thickness of 0.5-2.5 mm were selected. Dye permeation through dentin tubules with or without intrapulpal pressure (IPP) simulation, or after Single Bond Universal (SBU) application on dentin surface with IPP simulation were observed at the end of 0 min, 5 min, 30 min and 2 h. The teeth with residual dentin thickness of (1.0±0.1) mm were divided into 2 groups with IPP simulation of 15 or 0 cmH2O (1 cmH2O=0.098 kPa), which was maintained for 30 min before bonding procedure. SBU was applied on the dentin surface and light cured, then RelyX Ultimate (RLX) cement was heaped on the dentin surface (diameter=10 mm, height=4 mm) and light-cured. After the dentin-resin cement samples were stored in distilled water for 24 h at 37 ℃, the samples were cut into beams with cross sectional area of 0.9 mm×0.9 mm for μTSB testing (n=100). The data were analyzed with two independent samples t-test (α=0.05). The fracture mode was observed using scanning electron microscopy (SEM). The results were analyzed with Fisher exact test (α=0.05). The rest of dentin-resin cement samples (five samples for each group) were cut perpendicular to the bonding interface and the morphology of the bonding interface was observed using SEM.Results: The dye permeation through dentin tubules with IPP simulation was faster than those without IPP simulation. The μTSB of RLX to dentin with and without IPP simulation were (26.26±9.78) MPa and (28.70±9.0) MPa, respectively. The most frequent fracture mode was mixed-fracture mode. There was no significant difference between the two groups for neither bond strength nor fracture types distribution (P>0.05). Regarding the morphology of dentin-resin cement bonding interface, both groups showed 4-8 μm finger-like resin tags.Conclusion: With SBU pretreatment, the IPP simulation had no influence on the immediate bond strength of RLX to dentin.

    Study of bond strength of one-piece glass fiber posts-and-cores with flared root canals in vitro
    Yuan ZHANG,Jian-min HAN,Lin LIU,Xu-liang DENG
    2019, (2):  327-334.  doi: 10.19723/j.issn.1671-167X.2019.02.024    
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    Objective: To compare the effects of three kinds of fiber posts (CAD/CAM one-piece glass fiber posts-and-cores, prefabricated glass fiber post and light curing plastic fiber post) on the bond strength of flared root canals and the effect of thermal cycling on their bond strength.Methods: Extracted human single teeth (n=90) were endodontically treated and randomly divided into three groups (n = 30 each). The teeth were restored by three kinds of fiber post: CAD/CAM one-piece glass fiber posts-and-cores, prefabricated posts and light curing plastic fiber post. Following post cementation, the specimens were stored in distilled water at 37 ℃ for 7 days. Half bonded specimens of each group were submitted to thermal cycling (6 000 times, 5 to 55 ℃) prior to micro-push-out bond strength test. Fabrication of micro-push-out bond strength test specimens was conducted by precision slicing machine. The micro-push-out bond strength was tested using a universal testing machine, and the failure modes were examined with a stereomicroscope.Results: In CAD/CAM one-piece glass fiber posts-and-cores group, the bond strength of cervical, middle and apical was (9.58±2.67) MPa,(8.62±2.62) MPa,(8.21±2.48) MPa respectively before thermal cycling, and after thermal cycling the bond strength of cervical, middle and apical was (8.14±3.19) MPa,(6.43±2.47) MPa,(6.45±3.20) MPa respectively. In prefabricated posts group, the bonding strength of cervical, middle and apical was (3.89±2.04) MPa,(4.83±1.23) MPa,(4.67±1.86) MPa respectively before thermal cycling, and after thermal cycling the bond strength of cervical, middle and apical was (6.18±1.61) MPa,(5.15±1.94) MPa,(6.39±2.87) MPa respectively. In light curing plastic fiber post group, the bond strength of cervical, middle and apical before thermal cycling was (4.05±2.41) MPa,(1.75±1.70) MPa,(2.60±2.34) MPa respectively, and after thermal cycling the bond strength of cervical, middle and apical was (5.04±2.72) MPa,(1.96±1.70) MPa,(1.34±0.92) MPa respectively. Postal types and root canal regions were found to significantly affect the push-out bond strength. Compared with the other two groups, the one-piece glass fiber posts-and-cores had the highest bonding strength in the cervical, middle and apical. Temperature cycling has no significant effect on the micro push-out bond strength of three kinds of fiber posts.Conclusion: One-piece glass fiber posts-and-cores has better bonding strength and excellent bonding performance.

    Evaluation of one-piece polyetheretherketone removable partial denture fabricated by computer-aided design and computer-aided manufacturing
    Xin-xin LI,Yu-shu LIU,Yu-chun SUN,Hu CHEN,Hong-qiang YE,Yong-sheng ZHOU
    2019, (2):  335-339.  doi: 10.19723/j.issn.1671-167X.2019.02.025    
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    Objective: To explore a novel method for fabricating removable partial dentures (RPDs) using polyetheretherketone (PEEK) by computer-aided design and computer-aided manufacturing (CAD/CAM) technologies and to evaluate their fits for different assemblies in vitro.Methods: A standard stone cast of mandibular partial edentulous jaw was scanned using a lab scanner. Based on the digital cast, thirteen complete RPDs were designed combing dental CAD software and reverse engineering software, and then fabricated using PEEK by milling machine. Fits of assemblies were evaluated quantitatively by measuring the spaces between RPDs and casts. The gaps between RPDs and stone casts in different assemblies were duplicated using light-body silicone impression material and then measured using three-dimensional (3D) digital analysis methods in virtue of a dedicated software. Statistically, one-way analysis of variance (ANOVA) was used to compare the difference of gaps among assemblies in different shapes such as occlusal rest, denture base, and major connector. Paired-samples t test was used to compare the gaps difference for the similar shape assemblies in different areas.Results: One-piece PEEK RPDs were successfully designed and fabricated by CAD/CAM, and all the RPDs were well-seated on stone casts. The gaps between occlusal rests and casts [(84.3±23.6) μm] were significantly larger than those of denture bases [(32.5±27.8) μm] and major connectors [(49.9±47.0) μm], which meant that the fits of denture bases and major connectors were better than that of occlusal rests. However, the fits of all assemblies could be accepted clinically. For the similar shape assemblies in different areas, there were no significantly differences for gaps between distal extension denture bases [(25.1±55.3) μm] and non-extensive denture bases [(41.5±17.7) μm]. The gaps of occlusal rests adjacent and nonadjacent to the edentulous space were (86.1±29.8) μm and (80.8±42.1) μm respectively and there were no significantly difference between them either. These results implied that different locations had no apparent effect on the fits of assemblies.Conclusion: With the computer-aided design and computer-aided manufacturing technology, PEEK can be used to fabricate one-piece removable partial dentures. And all assemblies of the one-piece PEEK RPDs showed satisfying fits in vitro, indicating a promising clinical application in the future.

    Clinical evaluation of the effect of reducing tooth sensitivity caused by in office bleaching using dentifrices
    Zhi-qiang LUO,Yi ZHANG,Lin TANG,Yu-hua LIU
    2019, (2):  340-344.  doi: 10.19723/j.issn.1671-167X.2019.02.026    
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    Objective: To evaluate tooth sensitivity and the efficacy of in-office bleaching when using different desensitizing dentifrices.Methods: In total, 150 eligible individuals were recruited and randomized by computer-generated block randomization into three groups: potassium nitrate group (n=50), stannous fluoride group (n=50), and placebo group (n=50). Participants were asked to use a desensitizing dentifrice and toothbrush 15 days prior to and after the in-office bleaching. Each patient received a one-session in-office bleaching with 35% hydrogen peroxide whitening gel. The in-office bleaching included three 15 min operations, totally 45 min. Tooth sensitivity was evaluated by 100 mm visual analog scale (VAS) scores immediately 0 d and 1 d, 2 d, 7 d, 14 d, and 30 d after in-office bleaching. In total, 48 (96%), 45 (90%), and 46 (92%) individuals in the potassium nitrate, stannous fluoride, and placebo groups, respectively, completed the follow-up observations.Results: Data were analyzed using analysis of covariance (ANOVA). For tooth sensitivity produced by in-office bleaching, the mean VAS values of the three groups were analyzed. At 0 d immediately after surgery, the mean VAS of the potassium nitrate group was 39.22±15.08, which was lower than that of the stannous fluoride group (47.18±12.59) and the placebo group (52.53±14.05), and the difference was statistically significant (P<0.05). The results of the stannous fluoride group and the placebo group were similar, and the difference was not statistically significant (P>0.05). On 1 day postoperatively, the mean VAS of the potassium nitrate group was 38.27±16.52, which was lower than that of the stannous fluoride group (44.69±14.92) and the placebo group (44.45±13.54), P<0.05. The results of the stannous fluo-ride group and the placebo group were similar, and the difference was not statistically significant (P>0.05). The mean values of VAS were similar 2 d, 7 d, 14 d and 30 d after operation, and the difference was not statistically significant (P>0.05).Conclusion: Compared with the stannous fluoride group and the placebo group, the use of potassium nitrate desensitizing toothpaste 15 days before surgery can effectively alleviate the tooth sensitivity during and after in-office bleaching.

    Comparison of the minimally invasive treatments of laparoscopic and endosopic for common bile duct stones after gastrojejunostomy
    Ling-fu ZHANG,Chun-sheng HOU,Yong-hui HUANG,Zhi XU,Li-xin WANG,Xiao-feng LING,Gang WANG,Long CUI,Dian-rong XIU
    2019, (2):  345-348.  doi: 10.19723/j.issn.1671-167X.2019.02.027    
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    Objective: To explore the feasibility and to compare the merits and demerits of laparoscopic and endoscopic approach in removing common bile duct stones in patients with gastrojejunostomy after gastrectomy.Methods: Between January 2012 and December 2016, 25 patients with common bile duct stones after gastrojejunostomy received laparoscopic or endoscopic treatment in our centers. They were divided into laparoscopic group and endoscopic group based on treatment approaches for common bile duct stones, including 15 patients in laparoscopic group and 10 in endoscopic group. The clinical characteristics and outcomes between the two groups were retrospectively analyzed.Results: Among the 25 patients with gastrojejunostomy, the method of reconstruction was Billroth Ⅱ in 21 patients and Roux-en-Y in 4 patients. Six patients received laparoscopic or endoscopic treatment during the acute cholangitis state. Among the laparoscopic group, 5 patients with stones more than 1 cm, 7 patients with multiple stones, while in the endoscopic group, 3 patients with stones more than 1 cm and 4 patients with multiple stones. Fourteen patients in the laparoscopic group with coexisting gallbladder stones, and 6 of their common bile duct stones were successfully removed by transcystic approach without T tube drainage. Stone removals were successful in 4 patients of the endoscopic group by a single performance, including 3 patients with single small stone and one patient with multiple small stones. Two patients in the laparoscopic group were converted to open surgery for severe adhesion and one patient in the endoscopic group turned to laparoscopic operation for failing of finding papilla in the Roux-en-Y anastomotic status. The median hospital stays were 12 d and 10 d, respectively in the laparoscopic and endoscopic group. There were 3 patients with postoperative complications, including one patient with paralytic ileus in the laparoscopic group and 2 patients with biliary pancreatitis or bacteremia in the endoscopic group, and all of them recovered uneventfully with conservative treatment.Conclusion: Both laparoscopic and endoscopic approaches are feasible for removing stones in the common bile duct in patients with gastrojejunostomy after gastrectomy, and they complement each other. In addition, both techniques are difficult to conduct, and a technical competence should be considered in selection of each method.

    Establishment and preliminary clinical evaluation of edentulous custom trays designed and fabricated by chair-side CAD and 3D printing systems
    Kuan-paul WANG,Hong-qiang YE,Hu CHEN,Yong WANG,Yu-chun SUN,Yong-sheng ZHOU
    2019, (2):  349-355.  doi: 10.19723/j.issn.1671-167X.2019.02.028    
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    Objective: To design and fabricate edentulous custom trays by chair-side computer-aided design and 3-dimensional printing (CAD/3DP) system of independent research and development and to evaluate their clinical effects based on prosthodontists’ satisfaction using the visual analogue scale (VAS).Methods: Fifteen edentulous patients were randomly recruited by three prosthodontists who passed the unified operating process training. The custom trays for each patient were fabricated using both chair-side CAD/3DP system of independent development and manually conventional method, and the final impressions were made by silicone impression materials (light body). The prosthodontist’s satisfaction was surveyed by the three prosthodontists via the questionnaire based on visual analogue scales.Results: In the degree of the prosthodontist’s satisfaction of final impressions, the average satisfactions of “try in” (the overall size, shape, convenience, etc.) on the 3DP custom tray made by independent development chair-side system and the manually conventional method were 9.18±0.19 and 8.23±0.22, respectively. The average satisfactions of the border line position (border extensions, frenal notch)were 8.91±0.40 and 7.96±0.23, respectively. The average satisfactions of the stability in border molding were 8.80±0.83 and 8.01±0.81, respectively. The average satisfactions of the quality of final impression (completeness, thickness of impression material, exposure of custom tray, shape of border) were 8.94±0.68 and 7.99±0.42, respectively. The average satisfactions of the difficulty of high quality impression (times of repetition, efficiency) were 9.20±0.37 and 7.88±0.22, respectively. The average satisfactions of the overall satisfaction were 9.11±0.49 and 7.95±0.15, respectively. There was signi-ficant difference in the satisfaction of “try in”, border line position, stability in border molding, quality of final impression, difficulty of high quality impression, and overall satisfaction between the 3DP custom tray made by chair-side system of independent development and the manually conventional method (P<0.05).Conclusion: In the degree of the prosthodontist’s satisfaction of final impression, the 3DP custom tray made by chair-side system of independent development is higher than that of the conventional custom tray, and it meets the clinical requirements and can be popularized in clinical application.

    Lamotrigine induced hypersensitivity syndrome in children: a case report
    Ning-xun CUI,Xue-ping ZHU
    2019, (2):  356-358.  doi: 10.19723/j.issn.1671-167X.2019.02.029    
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    Drug induced hypersensitivity syndrome (DIHS) is often manifested as severe systemic drug trans-reactions characterized by acute and extensive skin lesions (mostly measles-like rash), fever, enlargement of lymph nodes, multiple organ involvement (hepatitis, nephritis, and pneumonia), eosinophilia and mononucleosis,within 2-6 weeks of the application of sensitizing drugs. In the early stage of the lesion, macular papules or erythema multiforme were common, and in severe cases, exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis were also common. Most of them deve-loped after taking allergic drugs for 2-6 weeks (average: 3 weeks). Symptoms persisted after discontinuation of allergic drugs. It takes more than one month to alleviate, which may endanger life in severe cases. Documents report that the most common drugs causing DIHS are phenytoin sodium, carbamazepine and phenobarbital aromatic drugs. However, it was reported that phenobarbital sodium was the most common anticonvulsant among allergenic drugs in children, followed by antipyretics, analgesics and antibio-tics, which may be related to the spectrum of childhood diseases and the particularity of the drug. Lamotrigine has been reported to cause DIHS in adults in China, but less in children. In order to improve the understanding of clinical diagnosis and treatment of DIHS in children, reduce misdiagnosis, missed diagnosis, and untimely treatment, and prevent the aggravation of the disease, we studied the case of a 4-year-old 7-month-old girl who presented with systemic erythematous papules, fever, hepatosplenomegaly, marked increase of white blood cells, marked decrease of anemia and platelets, abnormal liver function and coagulation routine after taking lamotrigine for one month due to epilepsy seizures. Now, accor-ding to the DIHS diagnostic criteria established by Registration of Severe Cutaneous Adverse Reactions Drug Review Group in 2007, plasma exchange was immediately given to replace the toxic metabolites in hemorrhagic plasma, and methylprednisolone was given intravenously for three days. At the same time, after symptomatic supportive treatments, such as loratadine and albumin, the condition gradually improved without recurrence. Through a case report of Drug reaction with eosinophilia and systemic symptoms in a child caused by lamotrigine, we can strengthen our understanding and improve the level of diagnosis and treatment of drug hypersensitivity syndrome in children. Lamotrigine can cause DIHS in children, which is very dangerous. Early diagnosis and early withdrawal of allergenic drugs, plasma exchange and glucocorticoid therapy are the key to treatment.

    Exogenous lipoid pneumonia induced by long-term usage of compound menthol nasal drops: a case report
    Ming LU,Wei YAN,Xiang ZHU,Hong ZHU
    2019, (2):  359-361.  doi: 10.19723/j.issn.1671-167X.2019.02.030    
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    Here we reported a case of exogenous lipoid pneumonia from Peking University Third Hospital. A 62-year-old male presented with chronic cough and expectoration for 8 years, without chest pain, hemoptysis or short of breath. He was an ex-smoker. In his past medical history, the patient reported chronic rhinitis sicca for 20 years. Chest computed tomography (CT) showed patchy ground glass opacities in his bilateral lower lobe. In recent 3 years, his symptoms showed slowly deteriorative changes, as did his chest CT findings. No improvement of the patient’s symptoms was observed, although he had been treated with many antibiotics. Then he was referred to our hospital for a detailed investigation for interstitial lung disease. On admission, the physical examination showed no abnormal findings except for inspiratory fine crackles in his bilateral lower lung field on auscultation. The results of the laboratory analysis, including complete blood cell count, biochemistry, arterial blood gas, urinalysis, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and tumor markers were all within normal ranges. To exclude the possibility of infectious or malignant conditions, bronchoscopy was performed. Secretions from the left lower lobe bronchus were collected for bacterial, fungal and fast-acid cultures, which were all negative. A bronchoalveolar lavage (BAL) was performed in the left lower lobe with a 30% recovery. The total cell count of the BAL fluid was 6.5×104/mL, and the cellularity diffe-rential revealed increased neutrophils(20%)and lymphocytes (17%). The cytological examination in the BAL fluid showed no malignant cells. All the clinical data above did not reveal any conclusive information. However, the pathological findings of his transbronchial lung biopsy (TBLB) were highlighted with lipid-laden macrophages engulfed by large vacuoles occupying almost completely the cytoplasm of the cells, which were consistent with those of exogenous lipoid pneumonia. Given these findings, it emerged that the patient was taking twice daily inhalations of a compound menthol nasal drops (essential oil of camphor, menthol and liquid paraffin) for his chronic rhinitis sicca for at least 10 years. Then he discontinued oil nasal sprays and showed gradual improvement 3 months later without intensive treatment. The presenting case report emphasizes the fact that chronic inhalation of nasal sprays and decongestants containing mineral oils was a cause of exogenous lipoid pneumonia, and clinicians should bear it in mind.

    Spinal cord stimulation for non-reconstructable chronic ritical limb ischemiae: a case report
    Wei-hao LI,Xue-min ZHANG,Zhi-bin HE,Xiao-ming ZHANG,Jing-jun JIANG,Tao ZHANG,Wei LI,Qing-le LI
    2019, (2):  362-364.  doi: 10.19723/j.issn.1671-167X.2019.02.031    
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    Peripheral arterial disease is one part of systematic atherosclerosis, becoming a heavy burden of human health. Patients in end stage of peripheral arterial disease manifest critical limb ischemia with severe rest pain and refractory ulcer. Surgical revascularization is the optimal option for patients with critical limb ischemia to avoid major amputation and improve quality of life. However, some of them contraindicate surgical revascularizations owing to coexisting morbidities. Spinal cord stimulation is reported to be effective and minimally invasive in pain relief and limb salvage for patients with limb ischemia. Here, we reported one case with chronic critical limb ischemia and gangrene of foot who underwent spinal cord stimulation, which was, as we knew, the first case in China. He was diagnosed with Burger disease and accompanied with history of stroke, chronic obstructive pulmonary disease and Castleman’s disease. It showed totally occlusive lesions of external iliac and femoropopliteal artery and no outflows below the knee in the computed tomography angiography. Given the complexity of lesions and weakness of the patient, spinal cord stimulation was indicated for control of rest pain and limb salvage. As specified, we implanted the temporary neurostimulator as the first step. After 2 weeks from temporary neurostimulator implantation, the patient achieved significant relief in intensity of pain, and acquired 20% improvement of transcutaneous oxygen pressure. The satisfactory results indicated probable effectiveness of spinal cord stimulation, thus we performed the permanent neurostimulator implantation 1 month later. During 2 months of follow-up, the patients stabilized at Fountain Ⅲ with pain relief with one kind of nonsteroidal anti-inflammatory drug. In our case, we confirmed the significant validity of spinal cord stimulation for pain control and consequent improvement of quality of life in non-reconstructable chronic critical limb ischemia. Furthermore, we reviewed that a number of published studies suggested that spinal cord stimulation be a reasonable option for patients with critical rest pain, especially who contraindicated surgical revascularization. The application of spinal cord stimulation in pain relief for non-reconstructable chronic critical limb ischemia was approved by related guidelines released by European Society of Cardiology and Trans-Atlantic Inter-Society Consensus. Further investigations are required for assessing the long-term outcome in limb salvage.

    Organ-sparing partial orchietectomy for testicular adenomatoid tumor
    Jian-fei YE,Bing WANG,Lu-lin MA,Lei ZHAO,Guo-liang WANG,Kai HONG
    2019, (2):  365-368.  doi: 10.19723/j.issn.1671-167X.2019.02.032    
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    Objective: The incidence of testicular tumors is relatively low which are mainly malignant, so the main way to treat testicular tumors is radical testicular resection. Testicular adenomatoid tumor is a rare testicular benign tumor, but is easily misdiagnosed as malignant tumors with removal of organs. This article aims to explore the clinical features of testicular adenomatoid tumor and its treatment.Methods: There were 133 cases of testicular tumor in the Peking University Third Hospital from May 1994 to November 2016. We conducted a retrospective analysis of three patients who underwent the treatment of partial orchiectomy with preservation of the organ and were pathologically diagnosed with testicular adenomatoid tumor after surgery. The follow-up was done by outpatient clinics and telephone inquiry after surgery. The related literature was also reviewed for further discussion.Results: Of all the 133 patients, 116 had radical resection of the testis and 17 had partial testicular resection due to specific reasons (5 cases of epidermoid cyst, 4 cases of teratoma, 3 cases of seminoma, 3 cases of adenomatoid tumor, and 2 cases of Sertoli cell tumor). The mean age of the 3 patients was (42.67±10.97) years (30-49 years), the mean hospital stay was (9.00±5.20) d (6-15 d), the mean body mass index was (26.20±1.42) kg/m 2 (25.00-27.76 kg/m 2), the mean serum human choionic gonadotophin (HCG) was (1.15±0.11) IU/L (1.07-1.23 IU/L) (all normal) and the mean serum alpha-fetoprotein (AFP) was (2.12±0.66) μg/L (1.65-2.58 μg/L) (both were normal). Ultrasound features revealed a clear or unclear border, solid, moderate echo nodule tumor in the testis. The mean maximal diameter of the tumor was (1.00±0.44) cm (0.50-1.30 cm), and the mean duration of intraoperative warm ischemia time was (19.67±17.10) min (0-31 min) (only the last two cases). No recurrence or malignant transformation was observed during the follow-up. Conclusion: Testicular adenomatoid tumor is mainly based on the characteristics of ultrasound to determine preoperatively, but easy to be misdiagnosed with testicular radical resection. The recommended surgery for adenomatoid tumor is partial resection of the testis via the inguinal approach according to the frozen section pathology to determine whether to retain the organ.

    Advances in epigenetic markers of dermatomyositis/polymyositis
    Yi-ying YANG,Xiao-xia ZUO,Hong-lin ZHU,Si-jia LIU
    2019, (2):  374-377.  doi: 10.19723/j.issn.1671-167X.2019.02.035    
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    Idiopathic inflammatory myopathy (IIM) is a rare group of autoimmune diseases, characte-rized by chronic muscle weakness, muscle fatigue and infiltration of single nuclear cells in skeletal muscle. Its subtypes include dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM) and immune-mediated necrotizing myositis (IMNM), and the most common subtypes are DM and PM. PM is an autoimmune disease mainly manifested by muscle damage. When the skin is involved, it is called DM. The incidence of IIM was relatively low, which was 1.16-19 per million people/year, but the mortality was high and the prognosis was poor. The pathogenesis of IIM is still unclear. Previous stu-dies suggest that both immune and non-immune mechanisms are involved in its pathogenesis, especially cellular and humoral immunity. In recent years, researchers have conducted a number of studies on the pathogenesis of IIM, especially in the study of DM/PM with the application of high-throughput biome-trics. Epigenetics is a discipline that refers to the genetic phenomena of DNA methylation spectrum, chromatin structure state and gene expression spectrum transferred between cells without any changes in DNA sequence, including DNA methylation, chromatin modification and non-coding RNA changes. A large number of studies have shown that epigenetic modification plays an important role in many diseases, especially in cancer. Recent studies have also found a series of epigenetic markers related to the occurrence and development of DM/PM, mainly in the aspect of non-coding RNA changes, such as miR-10a, miR-206, etc.. And there has also been some research on DNA methylation. However, no studies have been reported on whether chromatin modification is involved in the pathogenesis of DM/PM. The pathogenesis of DM/PM is complex and diverse. With the development of research, certain microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) may become biological markers for the early diagnosis of DM/PM. Therefore, this paper mainly expounds the research progress of the biomarkers of DM/PM from the aspect of epigenetics.


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Sponsor: Peking University
Editor-in-Chief: ZHAN Qi-min
Executive Editor-in-Chief: ZENG Gui-fang
Editing and Publishing: Editorial Department of Journal of Peking University (Health Sciences)
ISSN: 1671-167X
CN: 11-4691/R