Table of Content

21 May 2018, Volume 39 Issue 3

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Expression of CTLA-4 and CD28 in hemophilia A children with FⅧ inhibitor

Li Yang, Chen Zhenping, Li Gang, Zhen Yingzi, Wu Xinyi, Wu Runhui

2018, 39(3):  309-313.  doi:10.3969/j.issn.1006-7795.2018.03.001

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Objective To explore the expression of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and CD28 in children with hemophilia A inhibitor.Methods Data of a total of 58 children with hemophilia A (FⅧ:C ≤ 2%) in the Beijing Children's Hospital, Capital Medical University from December 1, 2016 to January 1, 2018 were collected, 28 cases were positive for the inhibitor and 30 cases were negative.Improved Nijmegen assay was used to test inhibitor titer and flow cytometry to test percentage of CD3、CD4、CTLA-4 and CD28 on T cells in peripheral blood. We analyzed the expression of CTLA-4/CD28 axis and CTLA-4+ Th cells, CD28+ Th cells of children with hemophilia A inhibitor positive and negative, and to determine the difference.Results The proportion of CTLA-4+Th cells in peripheral blood of children with FⅧ inhibitor was 2.95%(1.41%,5.50%), and negative group was 4.95%(2.20%,7.70%). The positive group was significantly lower than that of negative group (P=0.038). The expression of CD28+Th cells was not different. The CTLA-4/CD28 cell in peripheral blood of the positive group was 0.03 (0.01,0.06), and the negative group was 0.05 (0.02,0.08). the positive group was significantly lower than that of the negative group (P=0.042). There was no significant difference between the two groups in low titer group and high titer group.Conclusion The results of this study showed that expression of CTLA-4+T cells in peripheral blood of children with hemophilia A inhibitor positive was significantly lower than that in the negative children. We infer that the imbalance of CTLA-4/CD28 axis results in the development of inhibitor, while the insufficient expression of CTLA-4 is the main factor. Insufficient expression of CTLA-4 may be one of the important immunosuppressive effects of inhibitors generation.

Release of cytokines after joint bleeding and the formation of haemophilic arthropathy in children with severe hemophilia A

Liu Guoqing, Chen Zhenping, Tang Ling, Wu Xinyi, Zhen Yingzi, Li Gang, Wang Yan, Zhang Ningning, Zhang Jishui, Yu Guoxia, Wu Runhui

2018, 39(3):  314-319.  doi:10.3969/j.issn.1006-7795.2018.03.002

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Objective To explore the role of inflammatory factors[interleukin-1β(IL-1β),interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α)] in the formation of haemophilic arthropathy in children with severe hemophilia A, and to provide theoretical basis for further prevention and treatment target of hemophilia joint disease.Methods The eligibility hemophilia A children were enrolled from the Hemophilia Outpatient Clinic of Beijing Children Hospital during 2015-2016. Patients were divided into non-joint bleeding(NJB) group, joint bleeding(JB) group[acute joint bleeding(AJB) group, chronic joint bleeding(CJB) group]. Peripheral venous blood was collected, the expression of IL-1β, IL-6 and TNF-α in blood serum were detected by enzyme-linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA). The expression of mRNA of IL-1β, IL-6 and TNF-α was detected by reverse transcription-polymerase chain reaction (RT-PCR).Statistical analysis the levels of IL-1β, IL-6 and TNF-α in blood serum and their mRNA expression.Results A total of 47 cases were collected in the patients group, including 17cases of NJB group, 17 cases of AJB group (8 cases with target joint, 9 cases without target joint) and 13 cases of CJB group. Median age was 5.5 years (2 years to18 years). There was significant difference in the expression of mRNA of TNF-α between NJB group, JB group and AJB group(P<0.05). There was significant difference in the expression of mRNA of TNF-α between AJB group with arthropathy (n=8, 5.584±3.634) and AJB group without arthropathy (n=9, 1.680±1.590) (P=0.02).Conclusion The expression of IL-1β, IL-6 and TNF-α in children with hemophilia increased in acute joint bleeding, and the expression of TNF-α increased mainly in acute, chronic and with haemophilic arthropathy, so TNF-α is the key of cytokines in the formation of haemophilic arthropathy in children with severe hemophilia A.

Diagnostic value of 3.0T MRI multiple b value diffusion-weighted planar echo imaging for multiple myeloma

Wang Li, Jiang Tao, Jiang Hua, Gao Wen

2018, 39(3):  320-326.  doi:10.3969/j.issn.1006-7795.2018.03.003

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Objective To explore the optimal b value in diffusion-weighted 3.0T MRI scanning to diagnose multiple myeloma.Methods Fifty patients with multiple myeloma by clinical diagnostic criteria and twenty healthy volunteers were enrolled into this study. Following routine MRI scanning, sensitivity for diagnosis of multiple myeloma with different b values diffusion-weighted image (DWI) was 95% on 3.0-T MR unit. The image quality with different b values was analyzed and compared qualitatively by three scales system and quantitatively by signal-to-noise ratio (SNR). Apparent diffusion coefficient (ADC) between the MM group and the normal group was also measured.Results The smaller the b value was, the better the DWI image quality would be. Mean SNR of images obtained with b value 50, 600 and 1 000 s/mm² were 22.28±14.40,11.85±7.78,7.57±4.72 respectively. The difference among them was statistically significant (F=19.523, P<0.01) There was no significant difference between the mean ADC values on DWI with b value 600 s/mm²[(1.52±0.81)×10^-3 mm²/s] and 1000s/mm²[(1.32±0.74)×10^-3 mm²/s] (P>0.05). The mean ADC values of the normal volunteers group[(0.28±0.11)×10^-3 mm²/s] were significantly lower than that of the MM group[(1.32±0.74)×10^-3mm²/s] on DWI with b value 600 s/mm² (P<0.01).Conclusion A b value about 600 s/mm² is recommended when diffusion-weighted MRI scanning is used to diagnose multiple myeloma at 3.0 T MRI.

Clinical characteristics and prognosis of B-cell non-Hodgkin lymphoma with abnormal leukocyte count

Wang Kun, Zhang Jianhua, Zhang Ruijuan, Dong Chunxia, Ma Xiaowen, Shen Xing, Chen Kun, Chang Shuting, Yang Linhua

2018, 39(3):  327-334.  doi:10.3969/j.issn.1006-7795.2018.03.004

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Objective To raise our understanding of B-cell non-Hodgkin lymphoma (B-NHL) patients with an abnormal leukocyte count at diagnosis, by summarizing and analyzing the characteristics and prognosis.Methods Retrospective analysis was performed on B-NHL patients with an abnormal leukocyte count in the initial diagnosis who were seen during January, 2011 to December, 2017;the clinical features,routine laboratory tests,bone marrow examinations,early responses were summarized. Overall survival (OS) and progression-free survival (PFS) were assessed and analyzed for factors that may affect the clinical prognosis.Results The median age of 68 patients was 63 (19-80) years. Marginal zone B-cell lymphoma (MZL), diffuse large B-cell lymphoma (DLBCL) were the most common pathological subtypes. The Ann Arbor stage was in Ⅲ/IV stage or leukemic phase. Patients accompanied with anemia and/or thrombocytopenia accounted for 67.7%(46/68). The proportion of bone marrow involvement patients was 91.7% (55/60). Of 53 patients, 15 (28%) were accompanied with myelofibrosis; 40 patients were eligible for early response assessment,CR rate was 17.5%(7/40),and ORR was 55.0% (22/40). It was associated with the increased LDH, platelet count in the initial diagnosis and the improvement of bone marrow after the first treatment at early efficacy evaluation. Forty-three patients were followed up to January, 2018, the median follow-up time was 22 (1-70) months, the median PFS and OS were 13 (95% CI:2.721-23.279) months and 24 (95% CI:8.722-39.278) months, respectively. In a multivariate analysis, B-symptoms were the factors of OS, either CR or PR obtained through early treatment affected OS and PFS.Conclusion B-NHL with an abnormal leukocyte count had late phase,they often had B-symptoms and abnormal LDH. Bone marrow involvement was common in most patients,they were often found anemia and thrombocytopenia. A few patients achieved CR or PR after early treatment, they often had a short PFS. So further studies regarding long-term outcomes are required. Either CR or PR achieved through early treatment affected OS and PFS. Patients with leukemic phase could achieve better CR or PR if given ALL-intensive therapy,and more studies are needed.

Analysis of risk factors of young patients with deep venous thrombosis with pulmonary embolism

Feng Cuicui, Wang Fang, Han Xue, Bai Beibei, Zhao Sen, Chen Ye

2018, 39(3):  335-340.  doi:10.3969/j.issn.1006-7795.2018.03.005

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Objective To investigate the risk factors of young patients deep vein thrombosis (DVT) patients with pulmonary embolism (PE).Methods The data on clinical manifestations and common 17 risk factors were collected and retrospectively analyzed by statistical methods in 262 patients younger than 45 years old with DVT diagnosed by color flow duplex scan and/or by venography in Beijing Anzhen Hospital from January 2010 to December 2017. These patients were divided into PE group and non-PE group according to whether PE occurred.Results Of 262 patients, 36.6% (96/262) were confirmed to have PE, all of whom were secondary to lower limbs venous thrombosis (40.0%, 96/240). The average age was (34.85±7.96) years. Of PE group, there were higher level of C reactive protein (CRP), D-Dimer, fibrin degradation products (FDP) and lower high density lipoprotein-cholesterol (HDL-C) compared with non-PE group, and significantly more patients with the history of DVT, respiratory infection, multiple veins(≥ 2) involved than non-PE group. HDL-C, CRP the history of DVT and respiratory infection are independent risk factors based on multi-factor analysis.Conclusion Young patients with DVT easily develop into PE,which can lead to death. Screening for PE is essential to patients who have extremely elevated D-Dimer and FDP. We should take active intervention to the young patients with DVT when complicated with respiratory infection, patients who had the history of venous thrombosis, decreased HDL-C or elevated CRP.

Monoclonal protein and peripheral neuropathy

Hao Yuanyuan, Sun Wanling

2018, 39(3):  344-348.  doi:10.3969/j.issn.1006-7795.2018.03.007

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Monoclonal protein is produced by monoclonal plasma cells. When much monoclonal protein emerges in blood, it is named as paraproteinemia. Clinically, paraproteinemia is closely related to peripheral neuropathy (PN). This article has reviewed the pathogenesis, general disorders, diagnosis and treatment of PN in order to offer help in clinical practice.

Moderate regulatory effect of normobaric hyperoxia on nuclear factor-κB in cerebral ischemia-reperfusion injured rats

Shi Wenjuan, Zhao Yongmei, Qi Zhifeng, Huang Yuyou, Fang Yalan, Liu Kejian

2018, 39(3):  349-354.  doi:10.3969/j.issn.1006-7795.2018.03.008

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Objective To investigate the effect of normobaric hyperoxia (NBO) on expression of interleukin-1 β (IL-1β), tumor necrosis factor-α (TNF-α), nuclear factor-κB (NF-κB) and inhibitor of NF-κB (IκB) induced by cerebral ischemia-reperfusion injury in rats, and explore the effect of NBO treatment on inflammatory injury mediated by NF-κB after cerebral ischemia.Methods A total of fifteen healthy adult male SD rats (280-320 g) were randomly divided into Sham group (n=3), normoxia group (n=6) or NBO group (n=6). A model of middle cerebral artery occlusion for 90 min and reperfusion for 24 h was induced by using the intraluminal suture method. The sham group and the normoxia group rats breathed normal air, and NBO group rats were exposed to 100% oxygen after ischemia until reperfusion. Immunofluorescence staining and Western blotting were used to observe the expression of IL-1β, TNF-α, NF-κB and IκB in the core cerebral ischemic region.Results Immunofluorescence results showed that:1compared with Sham group, the number of IL-1β, TNF-α or nuclear NF-κB p65 positive cells in the core ischemic region of Normoxia group was increased significantly (P<0.05) with the fluorescence intensity increased; 2compared with Normoxia group, the number of IL-1β, TNF-α or nuclear NF-κB p65 positive cells in the core ischemic region of NBO group decreased significantly (P <0.05) with the fluorescence intensity decreased. Western blotting results showed that:1 compared with Sham group, the expression of NF-κB p65 increased and the expression of IκB decreased significantly in core ischemic region of Normoxia group (P <0.05); 2compared with Normoxia group, the expression of NF-κB p65 decreased and the expression of IκB increased significantly of NBO group (P <0.05).Conclusion NBO treatment may inhibit cerebral ischemia-reperfusion injury by regulating the activation of transcription factor NF-κB in core ischemic region, which imposes an effect on neuroprotection.

Effects of nitric oxide synthase inhibitor Nω-nitro-L-arginine methyl ester on the expressions of autophagy in the penumbra of rats following focal cerebral ischemia/reperfusion

Huang Yuyou, Fang Yalan, Shi Wenjuan, Liu Kejian, Zhao Yongmei

2018, 39(3):  355-359.  doi:10.3969/j.issn.1006-7795.2018.03.009

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Objective To explore the effects of nitric oxide synthase(NOS) inhibitor Nω-nitro-L-arginine methyl ester (L-NAME) on the production of nitric oxide (NO) and the expression of Autophagy-related proteins Beclin1 and LC3B in the brain tissues of rats with middle cerebral artery occlusion (MCAO)/reperfusion injury and to investigate the mechanism of neuroprotective effect induced by L-NAME.Methods Eighteen male Sprague Dawley rats were divided into 3 groups randomly:Sham group, MCAO group, and L-NAME group (n=6). MCAO was induced by suture method. The rats were underwent 90 min of right MCAO, and then reperfusion by withdrawing filament. Rectal temperature was monitored and kept in normal range during the operation. The rats were sacrificed and the brains were harvested at 24 h after reperfusion. The expressions of Beclin1 and LC3B were detected by immunofluorescent staining. And the spatial location of 3-nitrotyrosine (3-NT), the biomarker of NO-mediated protein damage, and Beclin1/LC3B were detected respectively by double immunofluorescence labeling.Results In Sham group, no 3-NT positive cells were observed. Little Beclin1 positive cells and LC3B positive cells distributed in the brain tissues. Compared with Sham group, the number of Beclin1 positive cells and LC3B positive cells increased significantly in the penumbra of MCAO group (P<0.05). Compared with MCAO group, the number of Beclin1 positive cells and LC3B positive cells decreased significantly in the penumbra of rats after received L-NAME on 24 h after reperfusion (P<0.05). Beclin1 and LC3B-positive immunoreactive cells were colocalized with 3-NT separately in the penumbra of ischemia/reperfusion rats.Conclusion L-NAME reduced the production of NO by inhibiting the activity of NOS, which could prevent neurons from oxidative stress injury directly. At the same time, L-NAME also inhibited the expression of autophagy, which might play an indirect role in neuroprotective effect.

Effects of chrysophanol on the expressions of p-CREB, BDNF and p-STAT3 in the brain of focal cerebral ischemia/reperfusion mice

Fang Yalan, Huang Yuyou, Zhao Yongmei, Li Jincheng, Duan Yunxia, Gao Li, Luo Yumin

2018, 39(3):  360-365.  doi:10.3969/j.issn.1006-7795.2018.03.010

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Objective To explore the effects of chrysophanol (CHR) on the levels of phosphorylated cyclic adenine monophosphate (AMP) response element binding protein (p-CREB), brain derived neurotrophic factor (BDNF), and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) in middle cerebral artery occlusion (MCAO)/reperfusion mice and to investigate the protective efficacy of CHR and the relative mechanism.Methods Totally 18 male C57BL mice were randomly divided into three groups:Sham group (n=6), MCAO group (n=6), and CHR group (CHR was intraperitoneally injected at a dose of 0.1 mg/kg for 14 days after reperfusion, n=6). MCAO was made by using the suture method. The mice were reperfused after right MCAO for 45 minutes. The mice were sacrificed and rapidly decapitated and the brains were separated on 14 d after reperfusion. Immunofluorescent staining was used to detect the levels of p-CREB and BDNF. And double immunofluorescence labeling was used to explore the cellular location of p-CREB and BDNF. Western blotting analysis was used to investigate the level of p-STAT3.Results 1) Many p-CREB positive cells were observed in Sham group. In the penumbra of MCAO group, the expression of p-CREB decreased significantly compared with Sham group (P<0.05). Compared with MCAO group, the expression of p-CREB increased significantly in penumbra zone of cerebral ischemia/reperfusion mice treated with CHR on 14 d after reperfusion (P<0.05). The p-CREB-positive cells were co-localized with general neuronal marker, NeuN, in the penumbra of ischemia/reperfusion mice. 2) A large number of BDNF-positive cells were observed in Sham group. The level of BDNF decreased significantly in the penumbra of MCAO group compared with Sham group (P<0.05). Compared with MCAO group, the expression of BDNF increased significantly in penumbra zone of cerebral ischemia/reperfusion mice treated with CHR 14 d after reperfusion (P<0.05). And BDNF-positive cells were co-localized with NeuN in the penumbra of ischemia/reperfusion mice. 3) The level of p-STAT3 increased significantly in ischemic brain tissue of MCAO group compared with Sham group (P<0.05). Compared with MCAO group, the level of p-STAT3 decreased significantly in ischemic brain tissue of cerebral ischemia/reperfusion mice treated with CHR 14 d after reperfusion (P<0.05).Conclusion CHR may provide long-term neuroprotective effect against cerebral ischemia/reperfusion injury by up-regulating the expressions of p-CREB and BDNF, and inhibiting p-STAT3 protein expression.

Risk factors for postoperative delirium and postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery

Mu Shanshan, Wu Yan, Wu Anshi, Liu Yang

2018, 39(3):  366-372.  doi:10.3969/j.issn.1006-7795.2018.03.011

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Objective To investigate the risk factors of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in elderly patients, and explore the relationship between POD and POCD.Methods Two hundreds and twenty ASAI-Ⅲ patients aged over or equal to 60 years old undergoing elective non-cardiac surgery were enrolled. Evaluate patients with the confusion assessment method(CAM) for diagnosis of POD on the day before and the 1st, 2nd, 3rd, 7th day after surgery. Also the neuropsychological test for diagnosis of POCD was evaluated on the day before and one week after surgery. According to whether with POD or POCD, the patients were divided respectively into two groups:POD group and non-POD group or POCD group and non-POCD group. Compare the perioperative clinical data between the two groups and binary Logistic regression analysis was used for definition the risk factors of POD and POCD. In addition, the patients were divided into two groups according to whether with POD to compare the rate of the incidence of POCD.Results The incidence of POD and POCD is respectively 12.8% and 44.1%. High ASA classification (OR=2.605,95% CI:1.160-3.067) and high visual analogue scale(VAS) score of the first day after surgery (OR=2.061,95% CI:1.024-2.549) are the risk factors of POCD in elderly patients. Gender (male) (OR=6.087,95% CI:1.685-14.893), high ASA classification (OR=4.548,95% CI:2.487-10.384),low body mass index(BMI) (OR=0.75,95% CI:0.601-0.939) and diabetes(OR=4.673,95% CI:1.209-8.674) are the risk factors of POD in elderly patients. The incidence of POCD in the POD group is 80%, which is much higher than the non-POD group (38.8%) (P<0.05).Conclusion High ASA classification and high VAS score of the first day are the risk factors of POCD in elderly patients. Male, high ASA classification,low BMI and diabetes are the risk factors of POD in elderly patients. The patients who have developed POD are easier to surfer from POCD.

Interaction between free radicals and zinc following cerebral ischemia/reperfusion injury

Fang Yalan, Yin Jie, Liu Kejian, Zhao Yongmei

2018, 39(3):  373-377.  doi:10.3969/j.issn.1006-7795.2018.03.012

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Cerebral ischemia/reperfusion induces the production of a large amount of free radicals, triggers oxidative stress, and results in the accumulation of intracellular zinc (Zn²⁺) in various ways. It is reported that the intracellular Zn²⁺ release and the generation of reactive oxygen species (ROS) are common ingredients in numerous toxic signaling mechanisms in neurons. Both Zn²⁺ ROS have been shown to accumulate during hypoxic-ischemic stress and play important roles in pathological processes. Liberated Zn²⁺ induces ROS generation by multiple mechanisms, including not only the induction of mitochondrial ROS production, and also the promotion of ROS formation outside the mitochondria by other routes such as interaction with NADPH oxidase. The interaction between Zn²⁺ and ROS eventually contributes to neuronal damage via apoptotic pathways or signal transduction. However, under certain conditions, Zn²⁺ has antioxidant activity and protects brain from injury. In this paper, the interaction between free radicals and Zn²⁺ following cerebral ischemia/reperfusion injury are reviewed.

Genetically-encoded calcium indicator for detecting the dynamics of drug-induced nuclear calcium signals in real time

Gong Mingtao, Zhang Chenguang, Ding Wei

2018, 39(3):  378-384.  doi:10.3969/j.issn.1006-7795.2018.03.013

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Objective To explore the application of genetically-encoded calcium indicator for detecting the dynamics of drug-induced nuclear calcium signals in real time.Methods We fused tdTomato with red fluorescence as an intramolecular reference to a most commonly used GeCI variant GCaMP6s, and tagged the molecule with the nucleoplasmin nuclear localization sequence (NLS) into an eukaryotic expression cassette. By transfecting HeLa or U87MG cells, and imaged with a live confocal microscope, we were able to quantitatively monitor the dynamic changes of nuclear calcium signals in real time.Results We found that the ability of Paxilline to increase nuclear calcium concentrations varied among different cell types. We also found that various chemical, including artemisinin and several cell stress inducing reagent, were able to elevate nuclear calcium level in a relatively persistent manner.Conclusion Different drugs can increase calcium concentration in non-excitable cells.

Effects of propylthiouracil addition in high fat diet on blood lipid, body weight and body fat of rats

Hao Weijia, Yang Qiushi, Li Jingyi, Ma Yi, Lu Li, Xiong Jie, Li Yuhang, Xu Pingxiang, Chen Yi, Xue Ming, Li Xiaorong

2018, 39(3):  385-392.  doi:10.3969/j.issn.1006-7795.2018.03.014

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Objective To investigate the effects of propylthiouracil on the body weight, body fat content and adipocyte size in hyperlipidemic rats induced by high-fat diets, and to investigate the applicability of the hyperlipidemia animal model induced by high fat diet containing propylthiouracil.Methods The SD rats were divided into 4 groups:normal diet, normal diet+propylthiouracil, high fat diet and high fat diet+propylthiouracil group, and were given the corresponding feed, and were given propylthiouracil 50 mg·kg^-1·d^-1 by gavage. The animals' feed intake, body weight, blood lipid, thyroid hormone levels were measured, and the Lee's index, liver index, perirenal adipose index, and epididymal adipose index were calculated. Oil red staining of liver tissue and HE staining of epididymal fat were made.Results Addition of propylthiouracil significantly increased lipid levels in animals given high-fat diet, with faster modeling speed and higher serum cholesterol level and low density lipoprotein-cholesterol (LDL-C), and liver lipid deposition.However, with prolonged intake of propylthiouracil, animal feed intake rapidly decreased,followed by animal body weight, perirenal fat and epididymal fat weight, adipocyte area, and Lee's index. At the same time, the animals showed dry and yellow hair, activity reduction, lags in response.Conclusion The addition of propylthiouracil is an effective method of making a model of hypercholesterolemia but with a significant reduction in body weight, body fat, and size of adipocyte.These characteristics were not consistent with the characteristics of common hyperlipidemia associated with high-fat diet in clinical practice. So addition of propylthiouracil is an effective method to mimic hypercholesterolemia associated with hypothyroidism, but it is not appropriate to characterize other types of hyperlipidemia.On the other hand, propylthiouracil has impact on a variety of lipid metabolism enzymes, may interfere with the correct judgment of drug's targets when doing a study on drug's lipid-lowering mechanism, therefore, it should be carefully selected according to the research purposes.

Occurrence and prognosis value of Snail and Claudin-3 expression in hepatocelluar carcinoma

Shen Yanjun, Chen Jinglong, Che Juanjuan, Wang Jing, Cao Bangwei

2018, 39(3):  393-397.  doi:10.3969/j.issn.1006-7795.2018.03.015

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Objective This study aimed to investigate the relationship between the expression of Claudin-3 or Snail and the clinical pathology and prognosis in the hepatocellular carcinoma (HCC) patients by detecting the expression of Claudin-3 and Snail in the HCC and liver cancer-adjacent tissues.Methods Snail and Claudin-3 were detected in cases of 60 liver cancer-adjacent tissues and 82 cases of HCC by using immunohistochemical technique. The postoperative prognostic factors were assessed by univariate Kaplan-Meier analysis and a multivariate Cox proportional hazard model.Results Snail positive expression was 69.47% in HCC and was significantly higher than liver cancer-adjacent tissues (P=0.001). Claudin-3 proteins positive expression were 47.61%in HCC and were significantly lower than liver cancer-adjacent tissue (P=0.002). The expression of Snail and Claudin-3 was negatively correlated (r=-0.430, P<0.01). Snail positive expression in HCC was significantly higher than liver cancer-adjacent tissues, and the difference was statistically significant in microvascular invasion and stages of pathology tumor lymph node metastasis (P<0.05). Multivariate analysis by using Cox regression model identified that Snail and Claudin-3 were independent prognostic factors of HCC (P<0.05).Conclusion The correlation between the Snail or Claudin-3 and the occurrence and invasion in HCC were exhibited. The combined detection of Snail and Claudin-3 protein in HCC patients might be an important pathological and prognosis biomarker in HCC patients.

Construction of small interference RNA lentiviral Vector for M₃ muscarinic acetylcholine receptor gene of bladder smooth muscle cells

Shang Zhenhua, Jia Chunsong, Yan Hao, Wang Jukun, Wang Xu, Cui Bo, Wang Qi, Ou Tongwen

2018, 39(3):  398-403.  doi:10.3969/j.issn.1006-7795.2018.03.016

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Objective To construct M₃ acetylcholine receptor gene interference RNA lentiviral vectors for bladder smooth muscle cells.Methods Four pairs of small interference RNA (siRNA) sequence for M₃ muscarinic acetylcholine receptor gene were synthesized to construct GV118-sh-M₃ lentivirus vectors. DNA sequencing was used to identify the sequence. GV118-sh-M₃ lentivirus vectors were cotransfected with pHelper 1.0 and pHelper 2.0 vectors into 293T cells. We harvested the viral particles and assayed the titer of lentivirus by fluorescence. BSMCs were primary cultured in vitro and transfected by lentivirus of four groups (KD1, KD2, KD 3 and KD4). Fluorescence expression was observed and the expression levels of M₃ gene in BSMCs of groups were assessed by RT-PCR and Western blotting was used to calculate interference efficiency.Results Four GV118-sh-M₃ lentivirus vectors were successfully constructed and the sequencing results were consistent with sequence of the design. Viral particles of groups were harvested with titer of 2×10⁸, 6×10⁸, 5×10⁸ and 5×10⁸ TU/mL, respectively. KD1 group was with the highest fluorescent expression and interference efficiency.Conclusion The GV118-sh-M₃ interference lentivirus vector was successfully constructed and selected, which may lay a foundation for further study on the study of M₃ muscarinic acetylcholine receptor gene interference in treating neurogenic bladder.

Association between the polymorphisms of 17beta-hydroxysteroid dehydrogenase type 5 or 6 and the risk of polycystic ovary syndrome: a systemic review and meta analysis

Li Qingchun, Xing Yingying, Jia Mengmeng, Cheng Xiaolin, Tian Xiaoyu

2018, 39(3):  404-412.  doi:10.3969/j.issn.1006-7795.2018.03.017

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Objective To systematically evaluate the association between 17beta-hydroxysteroid dehydrogenase type 5 (HSD17B5) and type 6 (HSD17B6) single nucleotide polymorphisms (SNP) and the risk of polycystic ovary syndrome (PCOS).Methods A comprehensive electronic search about published reports on the association of HSD17B5 or HSD17B6 gene polymorphisms with PCOS in China and abroad,which was conducted in PubMed. The Cochrane Library, EMBASE (OVID), CNIK, CBM, WangFang Date and VIP database and the retrieval time was up to June 2017. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data and assessed the bias risk of the included studies. The pooled ORs were performed using the Revman 5.3 software.Results Eight case-control studies were included:5 were about HSD17B5 rs3763676 that including 899 cases and 751 controls and 4 were about HSD17B6 rs3763676 that including 1 065 cases and 942 controls. The results of genetic model meta analysis in 3 studies showed no significant association between HSD17B5 rs3763676 gene polymorphisms and risks of PCOS(G vs A:OR=1.21,95% CI:0.98-1.49,P=0.070;GG+AG vs AA:OR=1.26,95% CI:0.85-1.86,P=0.250;GG vs AG+AA:OR=1.35,95% CI:0.86-2.12,P=0.190;GG vs AA:OR=1.47,95% CI:0.91-2.38,P=0.110;AG vs AA:OR=1.19,95% CI:0.79-1.78,P=0.410). Approximately, no significant association between HSD17B6 rs3763676 gene polymorphisms and risks of PCOS (C vs T:OR=1.13,95% CI:0.96-1.32,P=0.140;CC+CT vs TT:OR=1.06,95% CI:0.88-1.27,P=0.570;CC vs CT+TT:OR=1.48,95% CI:0.95-2.29,P=0.080;CT vs TT:OR=0.99,95% CI:0.81-1.21,P=0.950) except for CC vs TT codominant model(CC vs TT:OR=1.46,95% CI:1.02-2.09,P=0.040), but the results should be interpreted with caution.Conclusion Both HSD17B5 rs3763676 and HSD17B6 rs898611 single nucleotide polymorphisms are no associated with the risks of PCOS, but the results should be interpreted with caution.

Clinical analysis of diagnosis and surgical treatment of 35 patients with synchronous colorectal cancer

Wang Dong, Jin Lan, Yao Hongwei, Wang Jin, Zhao Xiaomu, Wu Guocong, Yang Yingchi, Zhang Zhongtao

2018, 39(3):  413-417.  doi:10.3969/j.issn.1006-7795.2018.03.018

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Objective To study the diagnosis, clinicopathological features, treatment, and prognosis of synchronous colorectal cancer (SCRC).Methods The clinical data and pathological features of the patients with SCRC admitted to Beijing Friendship Hospital, Capital Medical University from January 2008 to December 2016 were retrospectively analyzed.Results According to the inclusion criteria, 35 cases with SCRC were enrolled. Of which, Thirty-four cases were double primary carcinoma and one was triple primary carcinoma. 34 cases were first diagnosed and one was second diagnosed on three months after surgery. The detection rate of barium enema examination and colonoscopy was 60.9% and 70%, respectively while combination of colonoscopy and multiple imaging techniques increased the rate to 91.4%. Pathological analysis of the 71 tumor lesions suggested that adenocarcinoma accounted for 70.4% (50/71) and low/middle differentiated adenocarcinoma accounted for 54.9% (39/71). Thirty-two cases were treated with surgery, of which, 5 cases were treated with standard radical resection, 10 cases with extensive radical resection, 10 cases with regional radical resection, and 7 cases with total/subtotal colectomy. The postoperative 5 year survival rate was 59.4% and recurrence rate was 28.1%.Conclusion SCRC was mostly double primary carcinoma with adenocarcinoma as the dominative pathological type. Combining the results of multiple imaging examinations and colonoscopy may increase the detection rate of SCRC. Choosing appropriate surgical methods according to the specific situations of SCRC may improve the therapeutic efficacy of the patients.

Long-term efficacy of one-shot intra-arterial chemotherapy before radical cystectomy

Wasilijiang·Wahafu, Liu Sai, Wang Mengtong, He Qingbao, Song Liming, Ping Hao, Wang Mingshuai, Yang Feiya, Tian Xiquan, Niu Yinong, Xing Nianzeng

2018, 39(3):  418-422.  doi:10.3969/j.issn.1006-7795.2018.03.019

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Objective Evaluation of long-term outcome of one-shot intra-arterial chemotherapy as new adjuvant therapy before laparoscopic radical cystectomy(LRC).Methods We retrospectively analyzed the preoperative clinical data and follow-up results of 26 patients who received one-shot intra-arterial chemotherapy before LRC in Urology Department of Beijing Chaoyang Hospital from February 2006 to December 2015.Results All patients were performed one-shot intra-arterial chemotherapy 2-4 weeks before the LRC and completed laparoscopic procedure without open conversion (ileal conduit urinary diversion for 9 patients, orthotopic ileal neobladder for 15 patients and cutaneous ureterostomy for 2 patients). The average operation time was 373 min (210-600 min) with estimated blood loss of 407 mL (100-1 400 mL). All pathology was urothelial cell carcinoma of the urinary bladder with 6 low grade and 20 high grade. No positive surgical margins were reported. Compared with clinical TNM stages, pathological TNM stages demonstrated significant decrease (P=0.002):7 cases had no changed, 17 cases achieved a stage decrease, and 2 cases had risen. The average lymph node number was 17 (8-28) including 8 positive cases. There was no statistical difference in 30-day postoperative complications between the low grade and high grade tumor (P=0.081). The number of Clavien level 3 or higher complications within 30 day, 30 to 90 days, and more than 90 days were 3 cases, 1 case and 2 cases, respectively. The patients were followed up for 88 months (2-121 months). There were two cancer-specific deaths and one died of other causes during the follow-up period; however, no difference was found in terms of overall survival (P=0.746) and cancer specific survival(P=0.446) between the low grade and high grade tumor.Conclusion With long-term follow-up, one-shot intra-arterial chemotherapy did not significantly increase the post-operative complications, at the same time significantly decreased the pathological stage and grade. Randomized trials will be required to better assess the oncology outcome.

Evaluation of voriconazole guided by CYP2C19 gene polymorphism in the treatment of patients with invasive fungal infection

Niu Bingyin, Wang Guan, Chen Shicai, Weng Yibing

2018, 39(3):  423-427.  doi:10.3969/j.issn.1006-7795.2018.03.020

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Objective To determine effects of CYP2C19 gene polymorphism on standardized treatment of voriconazole in critically ill patients with invasive fungal infections and provide reference for clinical rational medication.Methods A non-randomized controlled study was used to compare the therapeutic efficacy, adverse reactions, and cost-effectiveness of genetically-directed voriconazole regimens and conventional voriconazole regimens in patients with invasive fungal infections. The PCR-RFLP method was used to detect the genetic polymorphism of CYP2C19 in patients.Results A total of 80 samples were included, including 40 test groups that were genotyped and 40 non-contemporaneous controls that were treated with conventional voriconazole for invasive fungal infections. The gene testers analyzed three sites of CYP2C19, a total of five two-site genotype combinations, including:681GG-636GG of an extensive metabolizer (EM), 681GA-636GG of an intermediate metabolizer (lM), and frequencies of 681GG-636GA and poor metabolites (PM) 681AA-636GG and 681GA-636GA were 12.17%, 52.16%, 6.22%, 17.54% and 11.91%, respectively. The therapeutic effect, cost-effectiveness and adverse reactions were significantly different in the EM group, IM group and PM group (P<0.05), and the PM group was significantly higher than the IM group, and the IM group was significantly higher than the EM group (P<0.05). Retrospective comparison with the control group showed that the experimental group was significantly lower than the control group in the average length of hospital stay and antifungal treatment costs.Conclusion CYP2C19 polymorphism can significantly impact the cost of standardized treatment,dosage, effects and adverse reactions of voriconazole,indicating that pharmacogenetics is important for rationalized medication of voriconazole.

Observation of curative effect of atomizing inhalation of Amikacin in the treatment of severe community-acquired pneumonia in the elderly

Fu Liming, Zhu Ping

2018, 39(3):  428-432.  doi:10.3969/j.issn.1006-7795.2018.03.021

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Objective The efficacy and safety of the treatment were discussed by atomizing inhalation of Amikacin in the treatment of elderly patients with severe community-acquired pneumonia (SCAP).Methods From January 2015 to December 2016, 106 cases of elderly patients with SCAP admitted to the department of emergency intensive care unit (EICU) in Luoyang Central Hospital affiliated to Zhengzhou University were randomly divided into the atomization group and the control group of 53 cases.There was no statistically significant difference between the two groups of age, gender, underlying disease, etiology and sensitivity to Amikacin (P>0.05).Control group was treated with conventional treatment, and atomization group was inhaled on the basis of conventional treatment.On two groups of mechanical ventilation time and ICU days, hospitalization days, antibiotic use time, Clinical Pulmonary Infection Score (CPIS) and acute Physical and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), bacterial clearance rate and fatality rate, total effective rate of treatment, and 28 days adverse reactions were analyzed.Results Mechanical ventilation time, ICU days, hospitalization days and antibiotic use time of Atomization group were (7.98±2.36) d, (9.81±1.90) d, (12.68±1.65) d, (11.21±1.40) d respectively.Control group was (9.62±2.70) d, (12.34±2.72) d, (14.94±2.73) d, (13.77±2.25) d. The data of the atomization group was shorter than that of control group. The difference was statistically significant(P<0.05). The 7th day CPIS score and APACHE Ⅱ score of atomization group were significantly lower than that of control group and the admission, the difference was statistically significant(P<0.05). The total effective rate and bacterial clearance in the atomization group was 76% and 81.13%, respectively, which was higher than 56.52% and 62.26% of the control group, and the difference was statistically significant(P<0.05). The mortality rate of 28 d in atomization group was slightly lower than that in control group, and the incidence of adverse reactions was low. There was no statistically significant difference between the two groups' 28 d mortality and the incidence of adverse reactions(P>0.05).Conclusion It is safe and effective of aerosolized Amikacin in the treatment of SCAP in the elderly and worth popularizing.

Clinicopathological observation of micronodular thymic epithelial tumors with lymphoid stroma

Wang Bei, Liu Hongyan, Zhang Honglei, Wang Xiuhong, Da Jiping

2018, 39(3):  433-438.  doi:10.3969/j.issn.1006-7795.2018.03.022

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Objective To investigate the clinicopathological features and prognosis of micronodular thymic epithelial tumors with lymphoid stroma.Methods Four cases of thymic epithelial tumours characterized by micronodular proliferation of tumour cells separated by abundant lymphoid stroma were collected in China-Japan Friendship Hospital from January 2014 to January 2018. Hematoxylin-Eosin staining, immunohistochemistry and in situ hybridization were performed to evaluate the pathological features.Results The average age of the 4 patients was (66.5±10.4) years, including 1 male and 3 female. All the patients had an anterior mediastinal mass without myasthenia gravis or autoimmune disease. The tumors were characterized by micronodular proliferation of tumour cells separated by abundant lymphoid stroma with prominent germinal centers. Two of them showed cytological atypia and increased nuclear mitosis. Immunohistochemical study showed that the tumor cells were strongly positive for CK and CK5/6. Additionally, the tumor cells with atypia were positive for CD5, CD117 and Bcl-2. Scattered CD3, CD5 and TdT positive immature T lymphocytes were noted in and around tumor nodules in 3 cases. EB virus was not detected in both tumor cells and lymphocytes. Altogether, 2 cases were diagnosed as micronodular thymoma with lymphoid stroma (MNT), 1 atypical variant of MNT, and 1 micronodular thymic carcinoma with lymphoid stroma. There was no tumor recurrence in 4 to 42 months after the operation.Conclusion Micronodular thymic epithelial tumor with lymphoid stroma is a kind of rare thymus tumor, and may constitute a spectrum in the continuum of benign and malignant lesions. Their prognosis is good after complete resection. The diagnosis should be based on a combination of clinicopathologic features and other types of thymus tumor should be excluded. The treatment should be conservative.

Comparison of efficacy and safety of transurethral pin-shaped electrode en bloc resection of bladder tumor and transurethral holmium laser resection of bladder tumor for non muscle invasive bladder cancer

Chen Siyang, Feng Lang, Du Yuan, Du Lindong

2018, 39(3):  439-443.  doi:10.3969/j.issn.1006-7795.2018.03.023

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Objective To evaluate the efficacy and safety of pin-shaped electrode in the transurethral en bloc resection of bladder cancer and transurethral holmium laser resection of bladder tumor for non muscle-invasive bladder cancer.Methods One hundred and thirteen cases with non muscle-invasive bladder cancer treated in Beijing Friendship Hospital from March 2015 to October 2017 were assigned to receive transurethral resection of bladder tumor. All the cases were divided into pin-shaped electrode group(n=63) and laser group(n=50) according to the operation method. The operation time, the amount of bleeding, bladder irrigation time, indwelling catheter time, hospitalization time and the recurrence rate in the follow-up period were compared between the two groups, and the data were statistically analyzed.Results All the cases were successfully undergone operation.There were no cases of open surgery and no cases of blood transfusion and no cases of bladder perforation during the operation. All case pathology can meet the requirement of pathological staging. There were 31 Ta cases and 82 T1 cases. There were 77 low grade tumor cases and 36 high grade tumor cases. All patients were followed up for 3-22 months, with an average of (11.4±5.8) months. The tumor recurrence was found in 6 cases in the pin-shaped electrode group(9.5%,6/63) and 7 cases in the laser group(14%,7/50). There was no progression case during the follow up period. There was no significant difference in the operation time, the amount of bleeding, bladder irrigation time, indwelling catheter time, hospitalization time and the recurrence rate in the follow-up period in the two groups(P>0.05).Conclusion Transurethral pin-shaped electrode en bloc resection of bladder tumor is a safe and effective therapeutic method for non muscle-invasive bladder cancer.It can effectively avoid the bladder perforation caused by the obturator nerve reflex and meet the needs of postoperative pathological diagnosis.

Observation of changing of perioperative serum ubiquitin carboxyl-terminal esterase-L1 in children with aortic coarctation

Tong Feng, Li Lei, Zhao Tao, Li Xiaofeng, Liu Yinglong

2018, 39(3):  444-448.  doi:10.3969/j.issn.1006-7795.2018.03.024

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Objective To examine serum ubiquitin carboxyl-terminal esterase-L1 (UCH-L1) levels in coarctation patients with and without cardiopulmonary bypass(CPB), and to evaluate whether UCH-L1 was a useful marker in predicting the brain injury associated with CPB after aortic arch operation.Methods Thirty-nine consecutive patients subjected to aortic repairs were enrolled, 22 patients received SCP(group B) and 17 did not receive CPB(group A). Serum was collected at six time points (after induction of anesthesia; closure of chest; 2 h, 8 h, 24 h, 48 h after operation). UCH-L1, S100β and neuron specific enolase (NSE) levels were measured by using a sandwich enzyme-linked immunosorbent assay. Neurologic function scores were recorded at 8 h after operation,6 h after extubation and before discharge.Results Baseline UCH-L1 protein levels in serum were similar to those of all groups[group A (0.184±0.066) μg/L, group A (0.194±0.067) μg/L. The concentrations of UCH-L1 in group B were elevated at 2 hours after operation significantly compared with group A[group A (0.238±0.067) μg/L vs group B (0.327±0.151) μg/L, P<0.05]and reached a peak at 8 h after operation. At 24 hours after operation, levels of UCH-L1 had no significant differences between the two groups[group A (0.208±0.078) μg/L vs group B(0.201±0.081) μg/L, P>0.05]. The correlation between CPB time and peak concentrations of UCH-L1 in group B was found to be statistically significant (r=0.575, P=0.005). Permanent neurological complications were not detected in all patients after operation.Conclusion Pediatric operation of the aortic arch with SCP causes a significantly greater increase in UCH-L1 serum levels than those of off-pump surgery and correlates with CPB duration. UCH-L1 can be a potential useful biomarker for the prediction of brain injury after CPB.

Analysis of the causes of decreased visual quality by chief complaint after refractive surgery in super high myopia patients

Zhao Shiqiang, Jie Ying, Li Lei, Zhang Li, Lu Hongshuang

2018, 39(3):  449-452.  doi:10.3969/j.issn.1006-7795.2018.03.025

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Objective To analyze the causes of decreased visual quality by chief complaint after refractive surgery in super high myopia patients.Methods Retrospective case series study was used. The subjects include 8 cases (16 eyes) of super high myopia patients who complained of a poor visual quality after receiving phacoemulsification of the crystalline lens and implantation of an intraocular lens or phakic intraocular lens implantation at Beijing Tongren Hospital, Capital Medical University from January 2009 to December 2015. Questionnaires were issued to investigate their postoperative visual quality. Patients' preoperative and postoperative diopter, preoperative and postoperative corrected distance visual acuity, uncorrected and corrected near visual acuity were measured in an effort to analyze the causes of the decrease of visual quality postoperatively. The mean age of super high myopia patients was (44.88±10.32) years old, ranging from 30 to 60 years old. The mean preoperative diopter was (-23.19±3.60) D, ranging from -29.0D to -18.0D. The mean postoperative diopter was (-0.73±1.31) D, ranging from -3.0D to 1.75D. Most of super high myopia patients were satisfied with the postoperative corrected distance visual acuity, however, they showed poor satisfaction with the postoperative uncorrected near visual acuity and corrected intermediate 30 cm visual acuity (P<0.05). The mean postoperative corrected distance visual acuity is 0.235, significantly higher than that prior to surgery, which was 0.187 (P<0.05). The postoperative uncorrected near visual acuity and corrected intermediate 30 cm visual acuity were much lower than that before surgery (P<0.05). With further vision correction, these patients could have their corrected near visual acuity equal to their preoperative uncorrected near visual acuity.Conclusion The major cause of the decline of visual quality in patients with super high myopia postoperatively was due to the decrease of near visual acuity, which mainly refers to the poor uncorrected near visual acuity and corrected intermediate 30 cm visual acuity.

Difference of the parotid microflora Alpha diversity of microflora between juvenile recurrent parotitis(JRP) and the normal children

Li Ying, Qi Senrong, Hua Lin, Shang Jiajian

2018, 39(3):  453-457.  doi:10.3969/j.issn.1006-7795.2018.03.026

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Objective To investigate the difference in the richness and diversity of the parotid microflora between juvenile recurrent parotitis(JRP) and the normal children.Methods The parotid saliva specimens were obtained from JRP and normal children(34 specimens from JRP,16 specimens from normal children) to analyze the diversity of the 16SrRNA gene sequence of of the microorganism using Illumina Hiseq 2500 PE250 high throughput sequencing platform.Results Compared with normal children, JRP had higher goods_coverage(P< 0.05), lower Chao1, abundance coverage estimator (ACE), Shannon (P < 0.05) and lower Simpson (P > 0.05).Conclusion Significant changes in the richness and diversity of parotid microflora between JRP and the normal children.

Rapeutic effect of azelastine nasal spray combined with desloratadine in the treatment of allergic rhinitis: a system review and Meta-analysis

Gao Zhanmei, Song Yang, Liu Hua, Wen Changlong, Sun Haiyang

2018, 39(3):  458-464.  doi:10.3969/j.issn.1006-7795.2018.03.027

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Objective To analyze therapeutic effect of azelastine nasal spray combined with desloratadine in the treatment of allergic rhinitis by Meta analysis.Methods Retrieved database:Chinese database includes CNKI, Wan Fang, VIP, CBM, etc. The English database includes PubMed, Embase, MEDLINE, Cochrane and so on. The quality evaluation was made by the Newcastle Ottawa Scale (NOS). Useing RevMan5.3 software to process data. The statistical effect index was selected by risk ratio (RR) value and 95%CI, I² and P values were selected as indicators of heterogeneity test, and sensitivity analysis, subgroup analysis were carried out. And conduct publication bias assessment. Publication bias was assessed by the Egger's method, if necessary further analysis will be made. Result Compared with azelastine nasal spray combined with desloratadine group and azelastine nasal spray group in the treatment of allergic rhinitis, Z=8.18(P<0.000 01), RR(95% CI):1.21(1.16,1.27) and the difference was statistically significant (P<0.05). Subgroup analysis showed that A group Z=5.62(P<0.000 01) and RR(95% CI):1.18(1.12, 1.26), and the difference was statistically significant (P<0.05). B Group Z=3.62(P=0.000 3) and RR(95% CI):1.19 (1.08, 1.31), the difference was statistically significant (P<0.05). C group Z=4.91(P<0.000 01), RR(95% CI):1.33(1.19, 1.50), the difference was statistically significant (P<0.05). Sensitivity analysis showed that Z=6.27(P<0.000 01), RR(95% CI):1.19(1.13, 1.26), the difference was still statistically significant (P<0.05).Conclusion Azelastine nasal spray combined with desloratadine is better than Azelastine nasal spray in the treatment of allergic rhinitis.

Research progress on photodynamic detection of peritoneal metastases using 5-aminolevulinic acid (ALA)

Ji Zhonghe, Liu Yang, Yutaka Yonemura, Li Yan

2018, 39(3):  469-475.  doi:10.3969/j.issn.1006-7795.2018.03.029

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Peritoneal metastasis (PM) has long been regarded as the terminal stage or cancer spreading. Since the 1990s, an integrated treatment strategy combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been gradually developed by the surgical oncology community, and has definitely improved the survival in selected patients with PM. In such comprehensive treatment strategy, completeness of cytoreduction (CCR) is the most important independent prognostic factor for survival benefit. The current CRS technique, however, is inadequate to identify the minute tumor nodules hidden at less accessible sites in the abdomen and pelvis. Thus PM still accounts for the most frequent form of cancer recurrence after CRS+HIPEC. There is an urgent need to develop sharper techniques to identify the minute PM nodules. Among the emerging technologies, photodynamic diagnosis (PDD) attracts the increasing attention for PM diagnosis. This review summarizes the application of 5-aminolevulinic acid (5-ALA) -based PDD for the diagnosis and treatment of PM.