2014年 · 第127卷第03期

With recent advances in both knowledge and available technology,therapeutic strategies for gastric cancer have become diversified.1 Surgical instruments and devices have improved,and chemotherapeutic drugs and targeted agents have become more advanced as we gain a more comprehensive understanding of gastric cancer biology.The epidemiology of gastric cancer has also been changing due to mass screening programs and improved survival rates.2 However,these collective achievements have not reached the point of making patients satisfied.The relationship between doctors and patients is a very sensitive and hot topic in Chinese medical fields.It is like complex hair knots that can not easily be smoothed without suffering and pain。

Abstract：Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy in patients with advanced gastric cancer (AGC).This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy (OTG) for AGC without serosa invasion.Methods From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion.Age,gender,and depth of invasion (pT2 and pT3) were matched by propensity scoring,and 116 patients (58 LATG and 58 OTG) were selected for analysis.Their clinicopathologic characteristics,postoperative outcomes,and survival were compared.Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups.Median number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups (30.8±10.2 vs.29.0±8.3).Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group (P ＜0.05,respectively).Rates of post-operative complications (12.1％ vs.15.5％) and postoperative mortality (0％ vs.1.7％),as well as cumulative survival rates,were similar.Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion.ProsPective.multicenter,randomized trials are needed to confirm the efficacy of LATG in this patient population。

Abstract：Background The insulin-like growth factor signaling pathway plays an important role in the modulation of cell growth and proliferation.The aim of this study was to investigate the role of polymorphisms of the insulin-like growth factor 2 (IGF2) and IGF-binding protein 3 (IGFBP3) genes,which encode key proteins of this pathway,as risk factors for gastric carcinoma (GC).Methods A case-control study including 404 histologically confirmed GC patients and 424 healthy controls of the same ethnicity was conducted to retrospectively investigate the genetic polymorphisms of two genes,IGF2+820A＞G (rs680) and IGFBP3 A-202C (rs2854744).Adjusted odds ratios (ORs) and 95％ confidence intervals (C/s) were calculated using Logistic regression.Results The IGF2 genetic variants examined contributed to GC risk individually (OR,1.26; 95％ CI,1.08-1.46).The genotype frequencies of IGFBP3 A-202C were not significantly different between the cancer cases and controls (P ＞0.05).Compared to the IGF2 AA genotype,carriers of one variant combined genotype were more pronounced among young subjects (＜60 years),male subjects,never smokers,and those with a family history of cancer (OR=1.36,95％ CI=1.09-1.72,P ＜0.05; OR=1.61,95％ C/=1.28-2.08,P ＜0.05; OR=1.46,95％ C/=1.11-1.98,P ＜0.05; OR=1.53,95％ C/=0.91-2.6,P ＜0.05; respectively).Moreover,when the combined effects of the risk genotypes were investigated,significant associations were detected between highrisk genotypes in IGF2 and IGFBP3 (OR,2.47; 95％ CI,1.75-3.49).Conclusions Our results suggest that polymorphic variants of the IGF2 genes modulate gastric carcinogenesis.Moreover.when the IGF2 and IGFBP3 variants are evaluated toaether,a areater effect on GC risk is observed。

Abstract：Background Endoscopic submucosal dissection of the esophagogastric junction is the most difficult gastric and esophageal dissection procedure.No reports of endoscopic submucosal dissection for Siewert type ii carcinoma of the esophagogastric junction have compared the outcomes of endoscopic submucosal dissection for all three Siewert types of adenocarcinoma.This study aimed to evaluate the efficacy and safety of endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction.Methods From October 2008 to June 2013,73 patients underwent endoscopic submucosal dissection for intraepithelial neoplasia of the esophagogastric junction.The patients were prospectively evaluated regarding the executability of the technique,short-term results of the procedure,en bloc resection rate,curative resection rate,complications and additional treatment after endoscopic submucosal dissection,and follow-up outcomes.Results Sixty-eight of the 73 patients (93.2％) underwent en bloc resection; the mean maximum specimen diameter was 33.7 mm.Fifty-seven of 61 patients (93.4％) who underwent curative resection were successfully followed-up for 1.0 to 56.0 months (average,24.1 months).Local recurrence developed in one patient with high-grade intraepithelial neoplasm.Twelve patients underwent noncurative resection,including lateral resection margin residues in three,vertical resection margin residues in one,signet ring cell carcinoma or undifferentiated adenocarcinoma in four,lymphatic or vessel invasion in one,vertical residual margin residues combined with signet ring cell carcinoma in one,and undifferentiated adenocarcinoma with lymphatic or vessel invasion in two.In the noncurative resection group,one patient was lost to follow-up,seven underwent additional surgery,and the remaining four were periodically followed up; none had local recurrence or distant metastases.The only complication was delayed bleeding in three patients,which was successfully controlled by conservative treatment or endoscopic therapy.Conclusions Endoscopic submucosal dissection is safe and effective for intraepithelial neoplasia of the esophagogastric junction.R0 en bloc resection is possible and can avoid the risk of local recurrence。

Abstract：Background Colorectal carcinoma is one of the most common malignant tumors.Despite advances in therapy,mortality is still very high.The aim of this study was to evaluate the expression of paxillin in the human colon adenocarcinoma cell line SW480 and its role in cell cycle and apoptosis.We also investigated the expression of paxillin in colorectal carcinoma tissues and its relationship to clinicopathological features and survival.Methods Paxillin short hairpin RNA (shRNA) was constructed and transfected into the colon adenocarcinoma cell line SW480.The influence of paxillin shRNA on the cell cycle and cell apoptosis was analyzed by flow cytometry.Immunohistochemistry staining was used to assess the expression of paxillin and its association with the expression of carcinoembryonic antigen (CEA),carbohydrate antigen (CA) 19-9,p53 and Bcl-2 in 102 patients with primary colorectal carcinoma.Western blotting was also used to investigate the expression of paxillin.Medical records were reviewed and a clinicopathological analysis was performed.Results In vitro,the percentage of cells in S phase was (45.23±1.05)％,(43.53±1.23)％,and (36.13±0.57)％ in the blank control group,negative control group,and paxillin shRNA group respectively.It was significantly decreased in the paxillin shRNA group (P=0.000).The early apoptosis index of the paxillin shRNA group (17.2±1.18％) was significantly increased compared to the control shRNA group ((13.17±1.15)％,P=0.013).Paxillin was positive in 71 (69.6％) patients,and it was found to be overexpressed in tumor tissues compared with normal adjacent tissues.Paxillin positive rate was higher in patients who are less than 50-years old (100.0％ vs.65.6％,P=0.016).Paxillin expression was associated with a high histologic grade of carcinoma (81.4％ vs.61.0％,P=0.031),a high rate of regional lymph node metastasis (22.5％ vs.13.0％,P=0.031),mesenteric artery lymph node metastasis (100.0％ vs.64.8％,P=0.008),distant metastasis (94.1％ vs.64.7％,P=-0.016) and a high Tumor Node Metastasis (TNM) stage (94.1％,73.2％,60.0％,and 50％,P=0.030).Multivariate analyses revealed that recurrence was associated with the rate of regional lymph node metastasis (P=0.001) and paxillin expression (P=0.024).Multivariate analysis indicated that the overall survival is related to the TNM stage (P=0.000).Conclusions In vitro,paxillin may promote cell proliferation and inhibit apoptosis in SW480 cells.Paxillin may be a potential metastasis predictor,and an independent prognosis factor of recurrence.It may also be related to poor patient outcomes,but was not an independent predictor of survival。

Abstract：Background Prophylactic para-aortic nodal dissection (PAND) has no proven benefits for potentially curable advanced gastric cancer.However,the value of therapeutic PAND for involved para-aortic nodes (PANs) in patients with locally advanced gastric cancers has not been determined yet.Methods Between 1998 and 2010,157 gastric cancer patients with 1-3 involved PANs underwent extended D2 (D2+) lymphadenectomy plus PAND (PAND group,n=69) or extended D2 lymphadenectomy alone (non-PAND group,n=88).The clinicopathologic features and prognostic data were compared between the two groups.A propensity score-adjusted analysis was used for a balanced comparison.Results The rate of PAN metastasis was 40.6％ (28/69) in the PAND group.The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group (43.7％ vs.31.8％,P=-0.044).Compared to the non-PAND group,the death hazard ratios in the PAND group were 0.45 (95％ CI 0.274-0.739; P=0.002) and 0.536 (95％ CI 0.328-0.861; P=-0.0097) by multivariate analysis without and with propensity score adjustment respectively.Recurrence rate at 5 years was 39.1％ in the PAND group and 43.2％ in the non-PAND group (P=0.628).Conclusion Extended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs。

Abstract：Background Paclitaxel (PAC) is the first-line chemotherapy drug for most breast cancer patients,but clinical studies showed that some breast cancer patients were insensitive to PAC,which led to chemotherapy failure.It was reported that Notch1 signaling participated in drug resistance of breast cancer.Here,we show whether Notch1 expression is related to PAC sensitivity of breast cancer.Methods We employed Notch1 siRNA and Notch1 inhibitor,N-[N-(3,5-difluorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester (DAPT),to down regulate Notch1 expression in human breast cancer cells MDA-MB-231,and detected the inhibition effect by Western blotting and reverse trans cription-polymerase chain reaction,respectively.After 24 hours exposure to different concentration of PAC (0,1,5,10,15,20,and 25 μg/ml),the viability of the control group and experimental group cells was tested by MTT.We also examined the expression of Notch1 in PAC sensitive and nonsensitive breast cancer patients,respectively by immunohistochemistry (IHC).The PAC sensitivity of breast cancer patients were identified by collagen gel droplet embedded culture-drug sensitivity test (CD-DST).Results Down regulation of Notch1 expression by Notch1siRNA interference or Notch1 inhibitor increased the PAC sensitivity in MDA-MB-231 cells (P ＜0.05).Also,the expression of Notch1 in PAC sensitive patients was much lower than that of PAC non-sensitive patients (P ＜0.01).Conclusion Notch1 expression has an effect on PAC sensitivity in breast cancer patients,and the inhibition of Notch1 increases paclitaxel sensitivity to human breast cancer。

Abstract：Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years).Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P=0.35 and P=0.40,respectively).Cox proportional hazards regression analysis showed that level of low-density lipoprotein (HR,4.06; 95％ CI:1.19-18.7,P=0.027) and AAA size (HR,2.18; 95％ CI:1.28-11.65,P=0.036) were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors,statins,AAA size and systolic blood pressure were independent predictors of the secondary pre-specified outcomes.Conclusions Coronary artery revascularization following the guideline recommendations did not increase the mortality and morbidity of Chinese with AAA who were undergoing repair.Absence of angiotensin converting enzyme inhibitors and statins,AAA size,and systolic blood pressure were powerful predictors of the clinical events。

Abstract：Background Brain tumor segmentation from magnetic resonance imaging (MRI) is an important step toward surgical planning,treatment planning,monitoring of therapy.However,manual tumor segmentation commonly used in clinic is time-consuming and challenging,and none of the existed automated methods are highly robust,reliable and efficient in clinic application.An accurate and automated tumor segmentation method has been developed for brain tumor segmentation that will provide reproducible and objective results close to manual segmentation results.Methods Based on the symmetry of human brain,we employed sliding-window technique and correlation coefficient to locate the tumor position.At first,the image to be segmented was normalized,rotated,denoised,and bisected.Subsequently,through vertical and horizontal sliding-windows technique in turn,that is,two windows in the left and the right part of brain image moving simultaneously pixel by pixel in two parts of brain image,along with calculating of correlation coefficient of two windows,two windows with minimal correlation coefficient were obtained,and the window with bigger average gray value is the location of tumor and the pixel with biggest gray value is the locating point of tumor.At last,the segmentation threshold was decided by the average gray value of the pixels in the square with center at the locating point and 10 pixels of side length,and threshold segmentation and morphological operations were used to acquire the final tumor region.Results The method was evaluated on 3D FSPGR brain MR images of 10 patients.As a result,the average ratio of correct location was 93.4％ for 575 slices containing tumor,the average Dice similarity coefficient was 0.77 for one scan,and the average time spent on one scan was 40 seconds.Conclusions An fully automated,simple and efficient segmentation method for brain tumor is proposed and promising for future clinic use.Correlation coefficient is a new and effective feature for tumor location。

Abstract：Background Combined emphysema and pulmonary fibrosis,including idiopathic pulmonary fibrosis (IPF),is a distinct disorder described with upper-lobe emphysema and lower-lobe fibrosis on chest computed tomography.Smoking appears to be the predominant risk factor for this disorder.We aimed to compare clinical features,smoking history,physiological and radiological findings between IPF with and without emphysema.Methods A sample of 125 IPF patients over a period of 48 months were evaluated.High resolution CT scans were reviewed blinded to clinical data.The IPF patients with or without emphysema were classified accordingly.Results The prevalence of emphysema in this IPF sample was 70/125.IPF with emphysema was significantly associated with smoking status (OR 63; 95％ CI 4.4 to 915; P=0.002) and smoking pack year (OR 1.1; 95％ CI 1.05 to 1.13; P=-0.000).The patients with IPF and emphysema had a higher decrease in carbon monoxide diffusing capacity adjusted for alveolar volume ((58±19)％ pred vs.(66:±:21)％ pred; P=-0.021) and a higher prevalence of pulmonary hypertension (24/70 vs.7/55; P=0.006).The two groups of patients had similar forced and residual volumes.No significant differences were found in cell differentials of bronchoalveolar lavage or the scores of fibrosis on chest CT.Survival of the patients with emphysema was significantly less than that of patients with IPF alone.Conclusions Cigarette smoking induces IPF combined with emphysema.Emphysema further impairs physiological function and increases the prevalence of pulmonary hypertension that leads to poor prognosis.The inclusion of the patients with combined pulmonary fibrosis and emphysema in IPF clinical trials may lead to under evaluation of the effect of treatment in patients。

Abstract：Background The clinical applications of fibrin glue span over several surgical modalities.The aim of this study was to evaluate the biocompatibility and biodegradation of different formulations of platelet-rich fibrin glue in vivo and examine its effects on the neovascularization of wound sites.Methods Human-derived single-unit fibrin glue was prepared.Incisions were made on the backs of rats,and these were coated with homemade glues containing different concentrations of aminomethylbenzoic acid (Groups A-F) or commercial adhesives (Group G).A sham control group was included (Group H).The wounds were examined by histological analysis and immunohistochemistry at several time points.Results Successful wound closure was achieved in all groups by day 12.Acute inflammation occurred during the first six days,but gradually disappeared.The longest sealant duration was achieved using the lowest concentration of antifibrinolytic agent in a 1:10 volume ratio with cryoprecipitate.Expression levels of the platelet endothelial cell adhesion molecule-1 were significantly higher in Groups A and C compared to the control groups (Groups G and H) on day 3 (P ＜0.05).Conclusions Single-unit platelet-rich fibrin glue has excellent biocompatibility and is associated with the upregulation of neovascularization.The addition of aminomethylbenzoic acid could prevent the degradation of fibrin glue。

Abstract：Background The aim of this research was to investigate the impact of post-transplantation adjuvant chemotherapy in the prevention of tumor recurrence and metastasis for hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation.Methods A total of 117 patients with HCC exceeding the Milan criteria who had undergone orthotopic liver transplantation (OLT) from August 2002 to February 2009 were enrolled and retrospectively analyzed.The patients were divided into four groups according to chemotherapy regimens and the impact of different chemotherapy regimens on survival,disease-free survival,and adverse effects were compared.Results One year survival rates for the gemicitabine,conventional chemotherapy,oxaliplatin plus capecitabine and the best supportive care (BSC) group were 87.5％,84.2％,81.6％,and 67.5％.The 3-year survival rates were 48.1％,25.9％,31.6％,and 33.7％,respectively for the four groups.One year disease free survival rates for the four groups were 69.8％,47.4％,53.8％,and 45.7％ respectively.And 3-year disease free survival rates were 43.2％,23.7％,23.6％,and 25.1％ for the four groups.Stratification analysis showed that the gemcitabine regimen and conventional chemotherapy could significantly improve the survival rate and disease free survival rate for HCC patients who had major vascular invasion and/or microvascular invasion after liver transplantation compared with BSC group.Conclusions For HCC patients beyond Milan criteria,especially who had vascular invasion and/or micorvascular invasion,post-transplantation adjuvant chemotherapy can significantly improve survival.Gemcitabine is a proper regimen for postoperative adjuvant chemotherapy.Conventional chemotherapy can also benefit patients,but the adverse effects are not satisfactory。

Abstract：Background Based on the excellent medical care and management system for Chinese veterans,as well as the detailed medical documentation available,we aim to construct a Chinese Veteran Clinical Research (CVCR) platform on noncommunicable diseases (NCDs) and carry out studies of the primary disabling NCDs.Methods The Geriatric Neurology Department of Chinese People's Liberation Army General Hospital and veterans' hospitals serve as the leading and participating units in the platform construction.The fundamental constituents of the platform are veteran communities.Stratified typical cluster sampling is adopted to recruit veteran communities.A cross-sectional study of mental,neurological,and substance use (MNS) disorders are performed in two stages using screening scale such as the Mini-Mental State Examination and Montreal cognitive assessment,followed by systematic neuropsychological assessments to make clinical diagnoses,evaluated disease awareness and care situation.Results A total of 9 676 among 277 veteran communities from 18 cities are recruited into this platform,yielding a response rate of 83.86％.8 812 subjects complete the MNS subproject screening and total response rate is 91.70％.The average participant age is (82.01±4.61) years,69.47％ of veterans are 80 years or older.Most participants are male (94.01％),83.36％ of subjects have at least a junior high school degree.The overall health status of veterans is good and stable.The most common NCD are cardiovascular disorders (86.44％),urinary and genital diseases (73.14％),eye and ear problems (66.25％),endocrine (56.56％) and neuro-psychiatric disturbances (50.78％).Conclusion We first construct a veterans' comprehensive clinical research platform for the study of NCDs that is primarily composed of highly educated Chinese males of advanced age and utilize this platform to complete a cross-sectional national investigation of MNS disorders among veterans.The good and stable health condition of the veterans could facilitate the long-term follow-up studies of NCDs and provide prospective data to the prevention and management of NCDs。

Abstract：Background Radiation-induced injury after accidental or therapeutic total body exposure to ionizing radiation has serious pathophysiological consequences,and currently no effective therapy exists.This study was designed to investigate whether transplantation of allogeneic murine compact bone derived-mesenchymal stem cells (CB-MSCs) could improve the survival of mice exposed to lethal dosage total body irradiation (TBI),and to explore the potential immunoprotective role of MSCs.Methods BALB/c mice were treated with 8 Gy TBI,and then some were administered CB-MSCs isolated from C57BL/6 mice.Survival rates and body weight were analyzed for 14 days post-irradiation.At three days post-irradiation,we evaluated IFN-Y and IL-4 concentrations; CD4+CD25+Foxp3+ regulatory T cell (Treg) percentage; CXCR3,CCR5,and CCR7 expressions on CD3+T cells; and splenocyte T-bet and GATA-3 mRNA levels.CB-MSC effects on bone marrow hemopoiesis were assessed via colony-forming unit granulocyte/macrophage (CFU-GM) assay.Results After lethal TBI,compared to non-transplanted mice,CB-MSC-transplanted mice exhibited significantly increased survival,body weight,and CFU-GM counts of bone marrow cells (P＜0.05),as well as higher Treg percentages,reduced IFN-Y,CXCR3 and CCR5 down-regulation,and CCR7 up-regulation.CB-MSC transplantation suppressed Th1 immunity.Irradiated splenocytes directly suppressed CFU-GM formation from bone marrow cells,and CB-MSC co-culture reversed this inhibition.Conclusion Allogeneic CB-MSC transplantation attenuated radiation-induced hematopoietic toxicity,and provided immunoprotection by alleviating lymphocyte-mediated CFU-GM inhibition,expanding Tregs,regulating T cell chemokine receptor expressions,and skewing the Th1/Th2 balance toward anti-inflammatory Th2 polarization。

Abstract：Background Oncofetal protein high-mobility-group AT-hook protein 2 (HMGA2) is reactivated in serous ovarian cancer (SOC) and its overexpression correlates with poor prognosis.To explore the mechanism,we investigated whether HMGA2 could avoid microRNA regulation due to gene truncation or 3' UTR shortening by alternative polyadenylation.Methods Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to evaluate the abundance of different regions of HMGA2 mRNA in 46 SOC samples.Rapid amplification of cDNA 3' ends (3' RACE) and Southern blotting were used to confirm the shortening of 3' untranslated region (UTR).5' RACE and Southern blotting were used to prove the mRNA decay.Results No significant difference in the ratio of the stable coding region to the fragile region was observed between SOC and control normal fallopian tubes,indicating that the HMGA2 gene is not truncated in SOC.Varying degrees of 3' UTR shortening in SOC samples were observed by comparing the abundance of the proximal region and distal region of the HMGA2 3' UTR.The ratio of the proximal to the distal region of the 3' UTR correlated significantly with expression of the HMGA2 coding region in SOC (r=0.579,P ＜0.01).Moreover,although the abundance of the HMGA2 coding region varied,all samples,including the very low expressed samples,exhibit relatively high levels of the proximal 3' UTR region,suggesting a dynamic decay of HMGA2 mRNA from the 5' end.The shortening of 3' UTR and the decay from the 5' end were confirmed by 3' RACE,5' RACE and subsequent Southern blotting.Conclusion Heterogeneous 3' UTR lengths render HMGA2 susceptible to different levels of negative regulation by microRNAs,which represents an important mechanism of HMGA2 reactivation in SOC。

Abstract：Background Kidney transplantation (KTx) is the primary therapy for children with renal failure.Unlike KTx in adult patients,it is commonly agreed that pediatric KTx in China is far behind that of America.There has been no systematic analysis of Chinese pediatric KTx reported.This study aimed to demonstrate the current status of pediatric KTx in China.Methods Registry data of pediatric KTx (1983-2012) from Chinese Scientific Registry of Kidney Transplantation (CSRKT) were retrospectively analyzed.Results There were 851 pediatric KTx from 102 transplant units.The recipients were (15.4±2.5) years of age,93.9％ of who were over 10 years old.Chronic glomerulonephritis and pyelonephritis accounted for 75.6％ of recognized primary diseases.Allografts were from deceased donors (72.2％) or living donation (27.7％).The patient survival for 1,3,5,and 10 years was 96.9％,94.2％,92.3％,and 92.3％ and the graft survival was 94.6％,91.4％,86.3％,and 79.2％,respectively.The majority of post-transplant complications were acute rejection and infections.Annual transplant reached the peak in 2008 (n=114),and decreased sharply in 2006 (n=41) and 2010 (n=57).The percentage of pediatric KTx in total KTx was highest in 2007 (1.95％) and decreased to trough level in 2010 (1.0％).Living donation increased by 32.5-folds from 2004 to 2008 and then decreased by 86.6％ till 2010.The percentage of living donation in pediatric or total KTx dynamically changed in a similar manner,while living donation ratio in pediatric KTx was much higher.Conclusions Kidney transplant can provide long-term benefits to pediatric recipients.Rejection and infections are worthy of concern during follow-up.Pediatric kidney transplant in China is very much lagging behind that in developed countries.Living donation played an important role in its development in the past decades.New strategies for implementation are encouraged to increase the priority of uremic children in organ allocation so as to promote its progress in China。

Abstract：Background Diffusion tensor imaging can evaluate white matter function in human brain.Fractional anisotropy is the most important parameter.This study aimed to find regional reduction of fractional anisotropy (FA) with aging in the whole brain and the changing rules of anisotropy with aging.Methods Fifty volunteers from 20 to 75 years old were divided into five consecutive age groups; a young group and four senior groups.FA values were calculated with diffusion tensor imaging (DTI) studio software.The difference of FA between the young group and the four senior groups were analyzed by analysis of voxel-level height threshold in Statistic Parametric Mapping (SPM),and the regions with decreased FA were obtained.The FA values of these regions were then extracted using an in-house developed program,and a multiple linear regression model was built to assess the influence of age and sex on the FA values of these regions.Results Eight regions,including frontal lobe,postcentral gyrus,optic radiation,hippocampus,cerebella hemisphere,corona radiate,corpus callosum and internal capsule,were found to have decreased FA.There was a strong negative correlation between age and the FA in the frontal lobe,postcentral gyrus,optic radiation,hippocampus,and cerebella hemisphere,while a weaker negative correlation in the corona radiate,corpus callosum,and internal capsule was found.The FA reduction in the frontal lobe,postcentral gyrus,optic radiation,hippocampus and cerebella hemisphere were found earlier than in the corona radiate,corpus callosum and internal capsule.There was no correlation between sex and FA in these regions.Conclusions The FA in the subcortical white matter area reduces earlier than that in deep white matter.The areas with decreased FA continuously enlarge with aqing.The FAs in these regions have a strong negative correlation with age。

Abstract：Background What benefits and toxicities patients acquire from the use of bevacizumab combined with first-line chemotherapy remains controversial.This study was performed to evaluate the efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer (mCRC).Methods Several databases,including PubMed,Embase,and Cochrane Library,were searched up to April 30,2013.Eligible studies were only randomized,controlled trials (RCTs) with a direct comparison between mCRC patients treated with and without bevacizumab.Overall risk ratio (RR),hazard ratio (HR),odds ratio (OR),and 95％ confidence intervals (CO were calculated employing fixed or random-effects models depending on the heterogeneity of the included trials.Results Six RCTs,including 1582 patients in chemotherapy plus bevacizumab group and 1484 patients in chemotherapyalone group,were included.Overall,the addition of bevacizumab to first-line chemotherapy increased overall response rate (ORR) by 4.5％,prolonged both progression-free survival (PFS) and overall survival (OS),and increased the rate of total Grades 3 or 4 adverse events (G3/4AEs) by 6.9％.Significant differences were found in ORR (RR=1.22 (95％ CI 1.01-1.46),P=0.03),PFS (HR=0.60 (95％ Cl 0.47-0.77),P ＜0.0001),OS (HR=0.83 (95％ Cl 0.70-0.97),P=0.02),and any G3/4AEs (OR=1.56 (95％ Cl 1.29-1.89),P ＜0.00001).Conclusion Bevacizumab is a valuable addition to the current first-line chemotherapy regimens used in patients with mCRC,because of conferring a significant improvement in ORR,PFS,and OS,even though it increased adverse events。

Abstract：Objective This article aimed to review the incidence of Helicobacterpylori (H.pylon) infection and its therapy.Data sources Relevant articles published in English were identified by searching in PubMed from 2000 to 2013,with keywords "H.pylori".Important references from selected articles were also retrieved from Elsevier,Wiley,EBSCO,and SPRINGER.The Chinese articles published were searched from China National Knowledge Infrastructure (CNKI).Study selection Articles about "prevalence","gastric carcinoma","peptic ulcer","gastroesophageal reflux disease","functional dyspepsia","pathogenic mechanism","therapy","eradication rate","antibiotic resistance",and "gene polymorphisms" were selected.Results The decreased infection rates of H.pylori could also be linked to the changed disease spectrum,such as the decreased morbidity and recurrence rate of H.pylori-related peptic ulcer,and the increased morbidity of gastroesophageal reflux.Although different treatment regimens have been used for H.pylori infection,the H.pylori eradication rate declined gradually.Due to primary resistance to antibiotics,the gene polymorphism of host and infected strain,and the therapy regimes,H.pylori eradication became even more difficult.Conclusions The prevalence of H.py/ori infection had been decreasing,but the rate of eradication failure has dramatically risen in many countries due to resistance to antibiotic.H.pylori therapy in clinical practice is becoming proqressively more difficult。

Heart failure,the final outcome of various heart diseases,has an increasingly high prevalence in China.Diagnosis,medical treatments,and community managements of heart failure are substantial clinical challenges.N-terminal-pro-B-type natriuretic peptide (NT-proBNP) is a useful biomarker for diagnostic and prognostic predictions in heart failure patients;however,the levels of reference value in normal Chinese populations are lacking.The usage of classic Western medicines has greatly improved;furthermore,the treatment pattem of the integration of Western treatments and traditional Chinese medicine (TCM) is also widely explored.Moreover,community managements of heart failure have been paid more attention and the long-term mechanism is being built.Here,we summarize the range of reference values of NT-proBNP in normal Chinese subjects,current therapies including Western treatments and especially TCM,as well as community care among people with chronic heart failure patients in China。

Vaginitis is a common infectious disease often associated with abnormal vaginal flora.Previous studies have shown that abnormal vaginal flora often cause bacterial vaginosis (BV),a risk factor of preterm delivery.Therefore,BV is a concern in pregnant women.Until now,few studies have focused on changes in vaginal flora in postpartum women.Watts et al1 identified BV as a risk factor for post-cesarean endometritis.However,Yang et al2 found that the incidence of BV is higher in postpartum women than in nonpregnant women.Our study measured the incidence of BV in postpartum patients and the factors influencing the disparity in incidence.Our study was designed to identify whether BV drug therapy is necessary in postpartum women。