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Systemic sclerosis (SSc) is an autoimmune rheumatic disease that is characterized by skin fibrosis with multi-organ involvement. In China, the standardized diagnosis and treatment for SSc is still lacking. Based on the diagnosis criteria and guidelines from China and abroad, Chinese Rheumatology Association developed the current standardization of diagnosis and treatment for SSc. The purposes of this guideline are to standardize clinical management for SSc in China, to interpret the key evaluation tools for SSc, and to recommend therapeutic principle and strategies.系统性硬化病是一类以皮肤纤维化为主要特征的多脏器受累的自身免疫性结缔组织病。在我国，系统性硬化病的规范化诊疗依然欠缺。中华医学会风湿病学分会在借鉴国内外诊疗指南的基础上，制定了本规范，旨在规范我国系统性硬化病临床管理方案，对评估疾病的关键方法予以解读，并对疾病的治疗原则、方案给予建议。.

Gastric cancer is the second most common and the second leading cause of cancer related mortality in China, which seriously endanger the lives and health of Chinese people. Due to the lack of typical symptoms and screening system of early gastric cancer, about 70% patients with gastric cancer are diagnosed as locally advanced disease in China. Radical resection is the main approach for locally advanced gastric cancer (LAGC), however, the clinical effect of gastrectomy alone or gastrectomy plus adjuvant treatment is limited. As a result, there has been increasing interest in the neoadjuvant treatment, which could potentially downstage tumor, eliminate tumor micrometastasis, reduce intraoperative dissemination and postoperative recurrence, thus improve the prognosis of patients with LAGC. The exploration and application of chemotherapy, radiotherapy, targeted therapy and immunotherapy of neoadjuvant treatment in LAGC have made continuous progress in recent years. To date, neoadjuvant therapy has been developed as a part of multimodality treatment for patients with LAGC.胃癌位居中国恶性肿瘤发病率和死亡率第2位，严重危害国人的生命和健康。由于早期症状不典型、筛查体系不完善，中国约70%的胃癌患者确诊时已处于局部进展期。根治性手术是局部进展期胃癌最主要的治疗方式，但单纯手术治疗和传统的手术联合术后辅助治疗效果均不甚理想。术前新辅助治疗具有降低肿瘤分期、减小肿瘤原发灶、消除肿瘤微转移、减少术中散播和术后复发、提高胃癌根治性切除率等优点。近年来，化疗、放射治疗、靶向治疗、免疫治疗在局部进展期胃癌术前新辅助治疗中的探索和应用不断取得进展。新辅助治疗已成为局部进展期胃癌重要的治疗模式。.

In recent years, osteoporosis (OP) has become one of the main diseases affecting the health of middle-aged and elderly people in China, and the prevalence of OP has increased significantly. The clinical diagnosis and treatment guidelines for this disease are also constantly updated. The overall principles speciallyemphasise that doctors and patients need to work together to negotiate the details of the diagnosis and treatment guidelines, in order to improve the OP clinical diagnosis and treatment rate. Therefore, patients' knowledge of the disease, understanding of clinical guidelines, and cooperation with doctors to implement diagnosis and treatment plans are very important. In this study, from the most concerned issues of the patients, we established the OP patient practice guideline working group. 14 recommendations, as the OP patient practice guidelines, are proposed in accordance with the relevant principles of the "World Health Organization guidelines development manual" and the international normative process.骨质疏松症（OP）的患病率明显上升，已成为我国中老年人群的重要健康问题，提高OP临床诊治达标率需医患携手共同协商诊疗过程中的细节。因此，患者对疾病的认识、对诊治指南的理解以及配合医生执行诊疗方案是非常重要的环节。本指南从患者关切的问题出发，采用《世界卫生组织指南制订手册》的规范流程和相关原则，组成OP患者实践指南工作组，提出OP患者实践指南推荐意见14条。.

The standard treatment for advanced gastric cancer remains surgery-based comprehensive treatment. The D2 radical surgery has made outstanding contributions to the standarlization of gastric cancer surgery, which has improved patients' prognosis and quality of life. In recent years, neoadjuvant chemotherapy has achieved a certain effect on the treatment of advanced gastric cancer. With the continuous development of the concept of membrane anatomy in gastric cancer surgery, new surgical challenges have also been raised. For patients after neoadjuvant therapy, there is heated controversy in the possibility of completing radical gastrectomy with membrane anatomical concept for gastric cancer. We believe that if neoadjuvant therapy pushes mesenteric cancer cell back into the mesentery, theoretically membrane anatomy combined with neoadjuvant therapy is beneficial to the treatment efficacy of advanced gastric cancer. However, membrane anatomy has two important problems when combined with neoadjuvant therapy: (1) After neoadjuvant chemotherapy, there are varying degrees of edema around the stomach tissue, which will affect the visualization of anatomic planes. In addition, because the patients' coagulation function is damaged to a certain extent, it is difficult to avoid bleeding or minimize bleeding during the operation. Therefore, it is still controversial whether the patients with gastric cancer after neoadjuvant chemotherapy can undergo radical gastrectomy with membrane anatomy. (2) For patients with complete pathological remission, whether to obtain the maximum rate of pathological remission through intensive neoadjuvant therapy, or to obtain the survival benefit of patients with membrane anatomy surgery in clinic is still controversial. Faced with these confusions, multi-center clinical researches on the application of membrane anatomy surgery after neoadjuvant therapy is the only solution.进展期胃癌的标准治疗方式仍然是以手术为主的综合治疗，以D(2)根治术为代表的外科手术对规范胃癌的外科治疗，改善患者预后和生活质量等方面做出了突出的贡献。近年来，新辅助化疗对进展期胃癌的治疗取得一定的疗效，随着胃癌外科领域的膜解剖理念的不断发展，对胃癌的手术方式也提出了新的挑战。对于接受新辅助治疗后的胃癌患者，是否能够完成膜解剖胃癌根治术是当下值得探讨的热点问题之一。我们认为，如果新辅助治疗使系膜边癌推向系膜内，理论上膜解剖手术联合新辅助治疗是有利于提高进展期胃癌疗效的。但膜解剖在新辅助治疗患者中存在两个重要问题：（1）新辅助治疗胃癌患者术中胃周组织普遍存在不同程度的水肿，干扰到层次的解剖，由于患者凝血功能的破坏造成出血明显，很难达到"微出血"或者"无血"，因此，对于新辅助化疗后胃癌患者是否能够实施膜解剖的胃癌根治术，尚存争议；（2）对于病理完全缓解的患者，是否需要行膜解剖手术，临床中是通过强化新辅助治疗来获得最大的病理缓解率，还是以膜解剖手术获取患者的生存获益，尚存争议。开展膜解剖手术在新辅助治疗患者中应用的多中心临床研究是解决众多临床困惑的唯一途径。.

// Chun Guang Guo 1 , Dong Bing Zhao 1 , Qian Liu 1 , Zhi Xiang Zhou 1 , Ping Zhao 1 , Gui Qi Wang 2 , Jian Qiang Cai 1 1 Department of Abdominal Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 2 Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Correspondence to: Dong Bing Zhao, email: dbzhao2003@sina.com Gui Qi Wang, email: wangguiq@126.com Keywords: gastric cancer, lymph node metastasis, nomogram, endoscopic resection, decision analysis Received: April 05, 2016 Accepted: December 25, 2016 Published: January 14, 2017 ABSTRACT Background: Lymph node status is crucial to determining treatment for early gastric cancer (EGC). We aim to establish a nomogram to predict the possibility of lymph node metastasis (LNM) in EGC patients. Methods: Medical records of 952 EGC patients with curative resection, from 2002 to 2014, were retrospectively retrieved. Univariate and multivariate analysis were performed to examine risk factors associated with LNM. A nomogram for predicting LNM was established and internally validated. Results: Five variables significantly associated with LNM were included in our model, these are sex (Odd ratio [OR] = 1.961, 95% confidence index [CI], 1.334 to 2.883; P = 0.001), depth of tumor (OR = 2.875, 95% CI, 1.872 to 4.414; P = 0.000), tumor size (OR = 1.986, 95% CI, 1.265 to 3.118; P = 0.003), histology type (OR = 2.926, 95% CI, 1.854 to 4.617; P = 0.000) and lymphovascular invasion (OR = 4.967, 95% CI, 2.996 to 8.235; P = 0.000). The discrimination of the prediction model was 0.786. Conclusions: A nomogram for predicting lymph node metastasis in patients with early gastric cancer was successfully established, which was superior to the absolute endoscopic submucosal dissection (ESD) indication in terms of the clinical performance.

Background Hydrogen sulfide (H2S) is endogenously generated from L-cysteine (L-Cys) by the enzymes cystathionine-β-synthase (CBS) and cystathionine-γ-Lyase (CSE). Hydrogen sulfide is also produced from D-cysteine (D-Cys) by D-Amino acid oxidase (DAO). Methods The H2S production was measured by the methylene blue assay. The expression of DAO was investigated by Western blotting and immunohistochemistry. The short-circuit current (Isc) was recorded using the Ussing chamber technique. Key Results The epithelium in rat jejunum possesses DAO, and generates H2S. D-cysteine, originally used as a negative control for L-Cys, significantly increases the H2S release, which is inhibited by I2CA, an inhibitor of DAO. In vitro study by Ussing chamber technique reveals that D-Cys decreases the Isc across the epithelium of the rat jejunum and enhances the Na+-coupled L-alanine transport. Conclusions & Inferences A novel pathway for the production of H2S by DAO exists in rat jejunum.

Treatment algorithm has not been established for early gastric cancer with signet ring cell carcinoma (SRC), which has a reported low rate of lymph node metastasis (LNM) similar to differentiated cancer. A cohort of 256 patients with early gastric SRC at our center between January 2002 and December 2015 were retrospectively reviewed. Multivariate logistic regression analysis was used to determine the independent factors of LNM. A nomogram for predicting LNM was constructed and internally validated. Additional external validation was performed using the database from Cancer Institute Ariake Hospital in Tokyo (n = 1273). Clinical performance of the model was assessed by decision analysis of curve. The overall LNM incidence was 12.9% (33/256). The multivariate logistic model identified sex, tumor size, and LVI as covariates associated with LNM. Subsequently, a nomogram consisted of sex, tumor size, and depth of invasion was established. The model showed qualified discrimination ability both in internal validation (area under curve, 0.801; 95% confidence interval [CI], 0.729–0.873) and in external dataset (area under curve, 0.707; 95% CI, 0.657–0.758). Based on the nomogram, treatment algorithm for early gastric SRC was proposed to assist clinicians in making better decisions. We developed a nomogram predicting risk of LNM for early gastric SRC, which should be helpful for patient counseling and surgical decision-making.

To investigate the safety and feasibility of laparoscopic wedge resection for gastric gastrointestinal stromal tumors (GIST).One hundred GIST patients treated in our department between 2010 and 2014 were retrospectively enrolled, and their clinicopathological data were reviewed. Fifty patients underwent laparoscopic wedge resection, and open surgery cases were 1∶1 matched by tumor diameter. The clinicopathological characteristics, perioperative related factors, postoperative nutritional status and short-term outcome were compared between the two groups.Among the clinicopathological characteristics, only the age was of statistical significance (61.58±10.43 vs. 56.40±9.82, P=0.012). Over fifty percent of the tumors occurred in the gastric body. Although the short-term survival did not show statistical significance, the laparoscopic group showed predominant advantages in estimated blood loss [(48.60±48.89) ml vs. (137.60±140.69) ml, P0.001], average hospital stay[ (12.14±4.32) d vs.(17.22±7.11) d, P0.001], oral intake time[ (3.76±1.73)d vs. (6.28±3.73)d, P0.01], decline of prealbumin [(0.07±0.04)g/L vs. (0.11±0.05)g/L, P0.001)], decline of transferrin [(0.51±0.29)g/L vs. (0.64±0.30)g/L, P=0.034]and complication (2.0% vs. 14.0%, P=0.027).Laparoscopic wedge resection is feasible and safe for GIST surgery, allows a rapid recovery and having a better nutritional status in patients, and is a less invasive approach for patients.

Propofol is a widely used intravenous general anesthetic. Acetylcholine (ACh) is critical in controlling epithelial ion transport. This study was to investigate the effects of propofol on ACh-evoked secretion in rat ileum epithelium.The Ussing chamber technique was used to investigate the effects of propofol on carbachol (CCh)-evoked short-circuit currents (Isc).Propofol (10Propofol inhibits CCh-induced intestinal secretion by directly targeting basolateral K

Gastrectomy was reported to be an excessive approach for early gastric cancer with signet ring cell carcinoma. This study was conducted to explore the feasibility of endoscopic submucosal dissection for early gastric with signet ring cell carcinoma. Data from 1067 patients who underwent gastrectomy for early gastric cancer were collected retrospectively. The association between the clinicopathological factors and the lymph node metastasis was analyzed by univariate and multivariate logistic regression analyses. Lymph node metastasis was confirmed in 17.2 % (184/1067) of patients. Meanwhile, the incidence of lymph node metastasis with each histology type was 13.1 % (26/198), 9.8 % (34/347), and 23.8 % (124/522) for signet ring cell carcinoma, differentiated carcinomas, and undifferentiated carcinomas, respectively. Signet ring cell carcinoma occurs more in women and young patients, with a higher predominance for mucosa. Various factors—including sex, tumor size, depth of tumor, and lymphovascular invasion—were found to be associated with lymph node metastasis for signet ring cell carcinoma (P

Background Propofol is a widely used intravenous general anesthetic. Acetylcholine (ACh) is critical in controlling epithelial ion transport. This study was to investigate the effects of propofol on ACh-evoked secretion in rat ileum epithelium. Methods The Ussing chamber technique was used to investigate the effects of propofol on carbachol (CCh)-evoked short-circuit currents (Isc). Key Results Propofol (10−2–10−6 mol/L) attenuated CCh-evoked Isc of rat ileum mucosa in a dose-dependent manner. The inhibitory effect of propofol was only evident after application to the serosal side. Pretreatment with tetrodotoxin (TTX, 0.3 μmol/L, n=5) had no effect on propofol-induced inhibitory effect, whereas serosal application of K+ channel inhibitor, glibenclamide, but not, an ATP-sensitive K+ channel inhibitor, largely reduced the inhibitory effect of propofol. In addition, pretreatment with either hexamethonium bromide (HB, nicotinic nACh receptor antagonist) or Cl− channel blockers niflumic acid and cystic fibrosis transmembrane conductance regulator (inh)-172 did not produce any effect on the propofol-induced inhibitory effect. Conclusions & Inferences Propofol inhibits CCh-induced intestinal secretion by directly targeting basolateral K+ channels.

e15000Background: To present an initial results of a phase III trial of Short Term radiotherapy (SCRT) followed by chEmotherapy (experimental group) versus Long-term chemoradiotherapy (CRT) (contro...

By use of hybridoma technique, we have prepared 6 monoclonal antibodies. As shown by antibody labeling of whole mount ovary, four of them recognized, respectively, the antigens which were spatial-temporally expressed during oogenesis. The B 2 antigens appeared very early in the germarium and were expressed mainly by cystocyte and nurse cells. Later, they were all transported and localized in the posterior of oocyte, F 9 antigens followed and were also transported and localized in the posterior of oocyte in the stage 7-8. Then, E 8 antigens appeared and mainly localized on the membrane of oocyte in the stage 9-10. C 3 antigens were expressed much later, at about stage 14. They localized like two caps in the perivitelline fluid at both ends of matured egg. Such specific expression and distribution pattern of all these antigens suggest their possible roles during oogenesis.

Zip gene is required during the late neurogenesis of Drosophila. Molecular analysis of zip gene revealed that it encodes an integral membrane glycoprotein, functioning as a cellular recognition and/or adhesion molecule. It has been cloned into an expression plasmid pWR 590. By expression of this plasmid in E. coli, a fusion protein of zip with lacZ has been purified and used to prepare polyclonal antibodies from rabbits. After being identified by West blotting, antibodies were used to react with the whole mount embryos of Drosophila. The results of this antibody labelling experiment showed that zip proteins are fundamentally synthesized after germ band shortening, supporting our previous predication that zip gene is involved in the late neurogenesis and that antibodies against zip recognize lateral neural fascicles as well as neurons in CNS, proving that zip protein expressed in CNS may play a role in the establishment and maintenance of neural fasciculation.