Xanthogranulomatous cholecystitis managed by laparotomy may go through troublesome clinical course: Reflection of severe inflammation

<正>To the Editor: Xanthogranulomatous cholecystitis(XGC) is an uncommon inflammatory disease of the gallbladder, and its incidence is reported to be 1.3%-5.2% [1]. XGC is diagnosed by histopathological examination, characterized by severe inflammatory destruction followed by a granulomatous reaction, marked proliferative fibrosis, and infiltration of inflammatory cells [2]. Despite being a benign disease,     

Paediatric surgery in the 21st century: The future is bright

The future of our society lies with our children, and they should be served best by well‐trained specialist paediatric surgeons. This is now the accepted standard of care in developed countries worldwide. In the present article, we describe the history of development of our specialty over the years, and look forward to the bright future in the coming years.     

Risk factor profile in Chinese‐Australian stroke patients living in Sydney

Aim: To examine and compare stroke risk factors and their management in stroke patients of Chinese descent versus English‐speaking background (ESB)‐Australian patients. Methods: Cohort study. Fifty‐one Chinese‐Australians and 119 ESB‐Australians who were admitted to hospitals within Sydney metropolitan area with a recent acute ischaemic or haemorrhagic stroke were recruited. Results: Chinese‐Australian patients tended to have a favourable smoking (0% current smokers vs 15%, P = 0.036) and drinking (5% current medium/heavy drinkers vs 17%, P = 0.005) pattern compared with the Australian patients. The prevalence of diabetes mellitus was higher in Chinese‐Australians (31% vs 10%, P = 0.003). The management of hypertension and atrial fibrillation (AF) in Chinese‐Australians was suboptimal (19% untreated hypertension vs 8%, P = 0.102; 78% AF not on Warfarin vs 51%, P = 0.264). Conclusion: The findings of this study suggest that targeting specific stroke prevention strategies may be useful for Chinese‐Australians. Larger‐scale studies need to be conducted to confirm these findings.     

Epigenetic silencing of microRNA-199b-5p is associated with acquired chemoresistance via activation of JAG1-Notch1 signaling in ovarian cancer

Epithelial ovarian cancer is a highly lethal and aggressive gynecological malignancy. The high mortality rate is due in part to the fact that many advanced cancer patients become refractory to current chemotherapeutic agents, leading to tumor recurrence and death. However, the underlying mechanisms leading to chemoresistance remain obscure. Here, we report that the loss of miR-199b-5p due to progressive epigenetic silencing leads to the activation of the JAG1-mediated Notch1 signaling cascade, thereby leading to the development of acquired chemoresistance in ovarian cancer. Using miRCURY LNA™ microRNA array and Q-PCR analyses of two pairs of cisplatin-sensitive and –resistant ovarian cancer cell lines, we identified miR-199b-5p as significantly down-regulated in cisplatin-resistant ovarian cancer cells and confirmed that miR-199b-5p is clinically associated with advanced and poor survival ovarian cancers. Interestingly, the loss of miR-199b-5p could be restored by 5-Aza-dC-mediated demethylation, and methylated specific PCR (MS-PCR), bisulfite-sequencing and pyrosequencing revealed that the promoter region of miR-199b-5p was hypermethylated. Computational and mechanistic analyses identified JAG1 as a primary target of miR-199b-5p. Notably, the reduced expression of miR-199b-5p was found to be inversely correlated with the increased expression of JAG1 using an ovarian cancer tissue array. Enforced expression of miR-199b-5p sensitized ovarian cancer cells to cisplatin-induced cytotoxicity both in vitro and in vivo. Conversely, re-expression of miR-199b-5p and siRNA-mediated JAG1 knockdown or treatment with Notch specific inhibitor γ-secretase (GSI) attenuated JAG1-Notch1 signaling activity, thereby enhancing cisplatin-mediated cell cytotoxicity. Taken together, our study suggests that the epigenetic silencing of miR-199b-5p during tumor progression is significantly associated with acquired chemoresistance in ovarian cancer through the activation of JAG1-Notch1 signaling.     

冠状动脉旁路移植术治疗冠心病合并糖尿病患者有效性和安全性的Meta分析

目的采用Meta分析方法评价冠状动脉旁路移植术(CABG)与经皮冠状动脉支架置入术(DES-PCI)比较治疗冠脉多支病变合并糖尿病患者的有效性和安全性。方法计算机检索e Cochrane Library、PubMed、MEDLINE、EMbase、CBM、CNKI、WanFang Data和VIP等数据库,并手工检索已发表的资料和会议论文,追索纳入文献的参考文献,收集有关冠脉多支病变合并糖尿病患者血运重建策略的随机对照试验,检索时限均从建库至2010年。由2位评价者根据纳入排除标准独立选择文献、提取资料和评价纳入研究的方法学质量,然后采用RevMan 5.0软件进行Meta分析。结果共纳入8个RCT,合计3 689例患者,其中CABG组1 814例,DES-PCI组1 875例。Meta分析结果显示:与DES-PCI组相比,CABG组能显著降低术后再次血运重建率[OR=0.27,95%CI(0.10,0.69),P=0.006]及主要心脑血管事件发生率[OR=0.49,95%CI(0.38,0.62),P<0.000 01],但在降低病死率[OR=0.84,95%CI(0.64,1.10),P=0.21]、脑血管事件发生率[OR=2.00,95%CI(0.97,4.14),P=0.06]及心肌梗死发生率[OR=0.92,95%CI(0.53,1.59),P=0.75]方面,两组差异均无统计学意义。结论 CABG治疗冠脉多支病变合并糖尿病患者的疗效明显优于DES-PCI。受纳入研究质量和数量所限,上述结论仍需更多大样本、多中心、前瞻性的随机对照研究加以验证。     

Desmin‐related myopathy

van Spaendonck‐Zwarts KY, van Hessem L, Jongbloed JDH, de Walle HEK, Capetanaki Y, van der Kooi AJ, van Langen IM, van den Berg MP, van Tintelen JP. Desmin‐related myopathy. Desmin‐related myopathy (DRM) is an autosomally inherited skeletal and cardiac myopathy, mainly caused by dominant mutations in the desmin gene (DES). We provide (i) a literature review on DRM, including clinical manifestations, inheritance, molecular genetics, myopathology and management and (ii) a meta‐analysis of reported DES mutation carriers, focusing on their clinical characteristics and potential genotype–phenotype correlations. Meta‐analysis: DES mutation carriers (n = 159) with 40 different mutations were included. Neurological signs were present in 74% and cardiological signs in 74% of carriers (both neurological and cardiological signs in 49%, isolated neurological signs in 22%, and isolated cardiological signs in 22%). More than 70% of carriers exhibited myopathy or muscular weakness, with normal creatine kinase levels present in one third of them. Up to 50% of carriers had cardiomyopathy and around 60% had cardiac conduction disease or arrhythmias, with atrioventricular block as an important hallmark. Symptoms generally started during the 30s; a quarter of carriers died at a mean age of 49 years. Sudden cardiac death occurred in two patients with a pacemaker, suggesting a ventricular tachyarrhythmia as cause of death. The majority of DES mutations were missense mutations, mostly located in the 2B domain. Mutations in the 2B domain were predominant in patients with an isolated neurological phenotype, whereas head and tail domain mutations were predominant in patients with an isolated cardiological phenotype.     

Genetic polymorphism in pathogenesis of irritable bowel syndrome

Irritable bowel syndrome(IBS)is a complex symptombased disorder without established biomarkers or putative pathophysiology.IBS is a common functional gastrointestinal disorder which is defined as recurrent abdominal pain or discomfort that has at least two of the following symptoms for 3 d per month in the past 3mo according to ROMEⅢ:relief by defecation,onset associated with a change in stool frequency or onset with change in appearance or form of stool.Recent discoveries revealed genetic polymorphisms in specific cytokines and neuropeptides may possibly influence the frequencies and severity of symptoms,as well as the therapeutic responses in treating IBS patients.This review gives new insights on how genetic determinations influence in clinical manifestations,treatment responses and potential biomarkers of IBS.     

Community‐based diabetic retinopathy screening in Hong Kong: ocular findings

Background: Diabetic retinopathy is one of the most common causes of blindness. Timely retinal evaluation is known to prevent or minimise visual loss. This study compared the prevalence of ocular disorders in patients who have and have not undergone a retinal examination since diagnosis of their type 2 diabetes mellitus (T2DM). Such data might be useful for planning purposes by health care authorities and agencies in Hong Kong. Methods: Patients with T2DM aged 30 years or over presented for standardised interviews and screening for diabetic retinopathy. The presence of ocular disorders was recorded and the severity of the retinopathy, if any, was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Results: For the 1058 subjects who participated in this study, the mean age at examination was 61.8 ± 10.5 (SD) years (range, 31–93 years). For the 891 subjects with known diabetes for one year or longer, 62.7 per cent had never undergone an evaluation for diabetic retinopathy since diagnosis of their T2DM. Of the 891 subjects, gradable fundus photographs were available for 853 subjects and nearly 2.0 per cent of these had sight‐threatening retinopathy based on the ETDRS classification. Those who had not had an eye examination since diagnosis of their T2DM were more likely to have sight‐threatening retinopathy than those who had a retinal evaluation (2.6 versus 0.6 per cent; p = 0.04). Conclusion: In our sample, over 60 per cent of patients with T2DM for one year or longer had not had a retinal assessment since diagnosis. The risk of developing sight‐threatening diabetic retinopathy appears to be higher for those who have not had a retinal assessment.