Redo Research Articles

The application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair

Objective To investigate the application of pedicled tunica vaginalis flap cover new urethra in redo and second-stage hypospadias repair. Methods Retrospective analysis was performed in 45 redo hypospadias repair cases, aged from 1 year 3 months to 9 years 4 months (median 5 years 3month). All patients were divided into urethral dehiscence after hypospadias repair (group A) and the second stage surgery of two-stage hypospadias repair (group B) based on medical history. According to the site of dehiscence, the group A were further divided into midshaft urethral dehiscence (A1) and glans and distal urethral dehiscence with urethral opening located on midshaft (A2). After new urethra was completed, the appropriate size of the pedicledtunica vaginalis flap was transferred to cover the new urethra. Results There was no scrotal hematoma occurred in all 45 cases, and somecomplications occurred, including scrotal swelling in 1 case, high-riding testicle in 2 cases, penile clockwise torsion in 1 case, urethrocutaneous fistula in 6 cases. All the 45 cases were followed up for 1 to 4 years, with mean of 1.8 years. One more urethrocutaneous fistula occurred in group A2 and 1 more urethrocutaneous fistula with urethral stricture occurred in group B. There was no penile curvature and urethral diverticulum occurred in all cases. Conclusions Pedicled tunica vaginalis flap could be used as waterproofing layer to cover new urethra in redo hypospadias repair and presented a low incidence rate of postoperative complications. Key words: Hypospadias; Tunica vaginalis flap; Urethrocutaneous fistula

Stented versus stentless open pyeloplasty in children

Objective The aim of this study was to compare between stenting and nonstenting in dismembered pyeloplasty as regards outcome, early and late postoperative results, and complications. Background Ureteropelvic junction obstruction is a common congenital urologic anomaly. Open pyeloplasty is the standard surgical treatment. Drainage following pyeloplasty using a double J stent prevents subsequent stenosis and urine leakage. Patients and methods This study was conducted on 20 pediatric patients (maximum age 16 years) with a primary diagnosis of ureteropelvic junction obstruction who were divided into two groups: Group 1, the stented group double J (10 cases). Group 2, the nonstented group (10 cases). Classic Anderson–Hynes pyeloplasty was performed for the two groups. Results A total of 20 patients were included in the study. 16 (80%) cases were male and four (20%) cases were female. Their ages ranged from 6 months to 15 years. The mean ± SD age was 6.75 ± 4.53 years. All cases were unilateral; 10 (50%) cases were right sided and 10 (50%) cases were left sided. Postoperative complications included the following: urinary tract infection in only one case in group 1, residual mild hydronephrosis in only one case in group 1 and three (30%) cases in group 2; clot formation in only one case in group 2, and urinoma in only one case in group 2. Conclusion Pyeloplasty with a diverting stent is technically feasible and safe. Only risks for multiple anesthesias and economic burden with stent removal are present. The specific indication when stented pyeloplasty needs to be performed is in redo pyeloplasty, solitary kidney, inflamed renal pelvis, and hugely distended renal pelvis.

Assessment of the perceived communication competence of senior undergraduate dental students: A study of the quality of data and orders written in prosthodontics' laboratory forms

Background: Although principled responsibilities are on dentists to prescribe and communicate prosthodontics information and requirements to dental technician, studies reveal a lack of communication. Moreover, skills and techniques that students develop during their clinical education are profoundly become attitudes. Aim: The aim of this cross-sectional study was to inspect and observe the quality of prosthodontics instructions and information submitted for both fixed and removable prosthodontics cases immediately at the end of each students' clinical session. Methods: Research ethical committee approved this study. A paper-based examination designed to find out the quality of instructions and nature of information. A self-structured questionnaire was constructed which included general data; year of study, age and gender of the dental student, information of the case type itself, and the clarity and correct instructions. Written instructions and the drawings were categorized as satisfactory and clear, a guide, unsatisfactory and poor, and none, outcome of treatment recorded at the delivery/cementation appointments. Results: Only 36.5% of the whole study samples were satisfactory and clear. Moreover, 37.4% were considered as a guide, 22.8% were unsatisfactory and poor, and 3.3% were without instructions. There was a statistical significance difference between the groups. Results showed that only 42.3% of prosthodontics cases approved on the intended day for delivery and/or cementation with minor adjustments. Nearly 14.6% rejected and unapproved (Redo). Only 9.75% of written information indicated disinfection. Conclusion: This study indicates weakness in communication between senior dental students (SDSs) and the laboratory dental technicians. SDSs are not competent in writing prosthodontics forms. The significance of acceptably completing the forms must be stressed throughout students' education.

Role of RNA-binding protein HuR in human adipocyte differentiation

Objective To investigate the expressions of RNA-binding protein human antigen R(HuR), fatty acid binding protein type 4(FABP4), fatty acid synthetase(FASN), and lipoprotein lipase(LPL)during the differentiation of human adipocytes, and to explore their possible roles. Methods Human adipose-derived mesenchymal stem cells were induced by adipogenic differentiation, and the adipogenesis of cells was observed by oil red O staining. The expressions of HuR, FABP4, FASN, and LPL mRNA and protein were detected by real-time PCR and Western blotting. After HuR was silenced by siRNA, the change of adipogenesis for human adipose-derived mesenchymal stem cells was observed and the expressions of adipogenic genes were detected. Results The expressions of HuR, FABP4, FASN, and LPL mRNA and protein were significantly increased after human adipose-derived mesenchymal stem cells were induced to differentiate into adipocytes(all P<0.01). After HuR expression was down-regulated by siRNA, the adipogenic level of human adipose-derived mesenchymal stem cells was reduced, with decreased protein levels of FABP4, FASN, and LPL(all P<0.05), which were without changes for their mRNA levels. Conclusion HuR promotes the differentiation of human adipocytes mainly via regulating the changes of FABP4, FASN, and LPL protein levels. (Chin J Endocrinol Metab, 2017, 33: 854-860) Key words: Adipocyte differentiation; RNA binding protein; Human antigen R; Adipocyte fatty acid binding protein; Fatty acid synthase; Lipoprotein lipase

Performar o outro: o reenactment como dispositivo de experiências imersivas

Este artigo investiga potencialidades artísticas e políticas de criações contemporâneas construídas sob a forma de reenactments documentais. O termo compreende espetáculos que convidam os espectadores a refazerem ações de pessoas previamente documentadas, a partir de dispositivos poéticos e tecnológicos específicos. Para desenvolver a análise, parto da minha própria experiência como pesquisadora-participante de obras criadas pelo diretor catalão Roger Bernat e pelo coletivo suíço-alemão Rimini Protokoll. A partir do diálogo com o conceito de dispositivo cênico (SÁNCHEZ, 2016; CORNAGO, 2015) exploro a hipótese de que a experiência imersiva de “performar o outro” colabora para problematizar e dilatar temporalmente a percepção do público sobre os contextos documentais abordados.

Esculetin Inhibits Adipogenesis and Increases Antioxidant Activity during Adipocyte Differentiation in 3T3-L1 Cells.

This study was conducted to investigate the anti-adipogenic activity of esculetin (ECT) which is reported to be attributable to the modulation of antioxidant enzymes during adipogenesis. After six days of ECT treatment of 3T3-L1 cells, lipid accumulation was determined by Oil red O staining. The levels of glutathione (GSH) and reactive oxygen species (ROS), and the activities of antioxidant enzymes including glutathione reductase, glutathione peroxidase (GPx), and catalase were examined. In addition, the protein expression of glutamate-cysteine ligase catalytic subunit (GCLC) and heme oxygenase-1 (HO-1) was measured by Western blot. ECT significantly inhibited lipid accumulation by approximately 80% and ROS production in a concentration-dependent manner. GSH level and GPx activity were increased by ECT by approximately 1.3-fold and 1.7-fold compared to the control group, respectively. GCLC and HO-1 expression were elevated by ECT. These results showed that ECT treatments strongly inhibit adipogenesis, increase GSH level, and upregulate the expression of GCLC and HO-1, possibly by decreasing ROS production in 3T3-L1 cells during adipogenesis.

Emodin reduces FFAs-induced fatty degeneration in HepG2 cells via the AMPK/SREBP-1 pathway

Objective To investigate the effects of emodin on the triglyceride metabolism and oxidative stress in steatosis in HepG2 cells and possible underlying mechanisms. Methods The appropriate concentration of emodin on HepG2 cells were detected by methyl thiazolyl tetrazolium (MTT) assay. HepG2 cells were induced to fat overaccumulation by 1 mmol/L free fatty acids (FFA) (oleate∶palmitate=2∶1). The model group exposed to 10 μmol/L, 20 μmol/L, 40 μmol/L emodin. The intracellular lipid accumulation was documented by Oil Red O staining and the content of triglyceride and total cholesterol was observed. Reactive oxygen species (ROS) was determined by flow cytometry. Western blotting was performed to analyze the protein levels of adenosine monophosphate-activated protein kinase (AMPK), phosphorylated AMPK, and sterol regulatory element-binding protein 1 (SREBP-1). Results Emodin reduced lipid accumulation and triglycerides (TG) content (P<0.05). At the same time, it significantly reduced ROS production (P<0.05). Moreover, the levels of AMPK and p-AMPK protein were significantly upregulated, and SREBP-1 protein was significantly downregulated with the treatment of emodin (P<0.01). Conclusions This study has demonstrated that emodin can reduce fatty degeneration induced by FFAs in hepatocytes, and this effect may be partially mediated by the AMPK/SREBP-1 pathway. Key words: Emodin/PD; Liver neoplasms; Fatty acids/AE; Sterol regulatory element binding protein 1; Protein kinases; Lipids; Oxidative stress

Eugenia polyantha enhances adipogenesis via CEBP-α and adiponectin overexpression in 3T3-L1

Fat cells or adipocytes are important sites in glucose metabolism where triglycerides are synthesised from the excessive glucose in blood. These cells are produced from a complex process called adipogenesis where preadipocytes are differentiated by chemical inducer into mature adipocytes. Herbs and plants have shown tremendous effects on adipogenesis. Eugenia polyantha is a tropical plant that has been used in Asian culinary preparations as well as traditional medicine in treating diabetes, arthritis and cardiovascular diseases. In this study, we examined the effect of water extract of Eugenia polyantha on 3T3-L1 cells differentiation in the presence and absence of insulin. Result shows that water extract of Eugenia polyantha alone failed to enhance differentiation, but addition of 1 μg/mL of insulin significantly increased the formation of adipocytes. Ten days treatment with Eugenia polyantha significantly increased the triglyceride content as measured by Oil Red O assay and glucose utilisation in medium by dose dependent manner. Intracellular CEBP-α, adiponectin and GLUT4 proteins were also expressed significantly during the treatment of low concentration of Eugenia polyantha. This study provides the first evidence of Eugenia polyantha sensitising effect on 3T3-L1 adipogenesis process by enhancing the expression of CEBP-α, adiponectin and GLUT4 proteins.

Preparation and evaluation of extracellular matrix scaffold of human adipose tissue

25 g normal adipose tissue was cut into pieces. Then repeated freeze-thaw,enzymatic digestion,organic solvent extraction and vacuum freeze-drying were performed.Adult adipose tissue extracellular tissue matrix was obtained. The traits of extracellular matrix scaffold were observed.HE staining, Masson staining and DAPI fluorescence staining were used to test the effectiveness of the decellularization.Immunohistochemistry was used to detect the reservations of extracellular matrix (Ⅳ collagen, laminin).Scanning electron microscopy was introduced to observe the ultrastructure of extracellular matrix scaffold, and universal mechanical testing machine was used to measure the mechanical properties of the scaffolds. Enzyme digestion method was used to extract human adipose-derived stem cells (hADSCs),and then the 3rd passage hADSCs were cocultured with extracellular matrix scaffold.CCK8 was introduced to assay cell proliferation activity,and scanning electron microscopy was used to observe cellular adhesion. The cells on the scaffold were induced to adipocytes and observed by freezing section and Oil Red O staining after 14 days. The extracellular matrix scaffold of adipose tissue was porous sponges architecture. The cells in tissue were relatively removed. The collagen and laminin were preserved relatively, and the mechanical properties did not decline too much. The cell proliferation, adhesion and differentiation on the scaffold was very well. The extracellular matrix scaffold of adipose tissue, prepared through the methods of physical, chemical, enzymatic digestion and vacuum freeze-drying method, keeps the main ingredients of extracellular matrix and presents a well cellular compatibility, therefore it should be an ideal biologic scaffold for adipose tissue engineering.

Suppressive Effects of Carotenoids on Proliferation and Differentiation of 3T3-L1 Preadipocytes

Obesity results from excessive growth and expansion of adipose tissue due to preadipocyte proliferation and differentiation as well as excess lipid accumulation. The aim of the study was to assess the effects of bixin, lycopene, and β-carotene on proliferation and differentiation of 3T3-L1 preadipocytes. The cell viability was determined by MTT assays and their differentiation was evaluated by Oil red O staining and monitoring the expression of peroxisome proliferator-activated receptor gamma (PPARγ) and fatty acid binding protein 4 (FABP4). The expression levels of leptin and acetyl-CoA carboxylase (ACC) were measured by West blots. The results showed that bixin, β-carotene and lycopene reduced the viability of 3T3-L1 preadipocytes and inhibited intracellular lipid accumulation. β-Carotene had stronger suppressive effects on lipid accumulation than bixin and lycopene. Treatments of these carotenoids obviously reduced expression levels of PPARγ and FABP4 proteins in 3T3-L1 cells. The carotenoids down-regulated leptin expression, but up-regulated ACC expression during adipocyte differentiation. Bixin, lycopene and β-carotene suppressed differentiation of 3T3-L1 preadipocytes through down-regulating protein expressions of PPARγ and FABP4 as well as leptin.

Anatomy, histology and histochemistry of accessory sex glands in male Persian squirrel (Sciurus anomalus)

Persian squirrel (Sciurus anomalus) is a species of squirrels in the Middle East. There is little information about the anatomy and histology of various organs of this species. Moreover, there are no practical data about the accessory male sex glands of this species of squirrel. In this study the anatomical, histological and histochemical properties of the male reproductive system accessory glands of Persian Squirrel was evaluated. Eight adult male squirrels were anesthetized and euthanized. The pelvic area was dissected and the male reproductive system was separated. The accessory sex glands were investigated for gross anatomical aspect. Samples were fixed in formaldehyde for histological and histochemical studies. The coagulating glands, prostate and bulbourethral glands were observed at gross anatomical level. A single heart-shape and compact prostate gland was situated on the dorsal side of pelvic urethra. Two small coagulating glands were observed on the cranio-dorsal side of prostate. Two large spiral shape bulbourethral glands were situated out of the pelvic cavity near the root of penis on both sides of anal area. Histologic studies revealed that all accessory sex glands were alveolar glands with cuboidal to columnar epithelium. The most positive reaction for PAS stain was observed in the trabeculae of glands. There was no positive reaction for lipids in glands stained with Oil red O and Sudan Black. Some anatomical differences were observed in the accessory sex glands of Persian Squirrel in comparison to other rodents, however the histology of glands was almost similar to other rodents.

The comparison of biological characteristics of three kinds of stem cells in human degenerative intervertebral disc

Objective To compare the biological characteristics of nucleus pulposus-derived stem cells (NPSCs), annulus fibrosus-derived stem cells (AFSCs) and cartilage endplate-derived stem cells (CESCs) from the same patient who had degenerative disc. Methods The human discs isolated from 7 patients with intervertebral disc herniation were separated carefully and digested and filtered before getting the original NPSCs, AFSCs and CESCs. When cultivated to third passage, the cell activity of stem cells was analyzed by using cell counting kit-8 (CCK-8); multilineage (adipogenic, osteogenic and chondrogenic) differentiation potential was analyzed to define different stem cells. The total RNA of third-passage-cells was extracted, and then reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the relative expression of adipogenic, osteogenic and chondrogenic differentiation-related genes. Results Cell morphology of NPSCs, AFSCs and CESCs from the same patient showed no significant difference. The growth curve showed that proliferative ability of CESCs (A value at day 1, 3, 5, 7, 9, 11, 13, 15 was 0.35±0.01, 0.52±0.02, 0.64±0.08, 0.80±0.19, 0.79±0.2, 1.06±0.11, 1.37±0.09, 1.31±0.41) and AFSCs (0.38±0.01, 0.50±0.03, 0.72±0.06, 0.82±0.13, 0.87±0.08, 0.87±0.09, 1.20±0.05, 1.43±0.05)was more active than that of NPSCs (0.32±0.02, 0.42±0.04, 0.59±0.01, 0.64±0.17, 0.65±0.19, 0.68±0.21, 0.67±0.12, 0.59±0.12). Multilineage differentiation results showed adipocyte-like red by oil red O, osteocyte-like cells were stained red by Alizarin red, and chondrocyte-like cells blue by toluidine blue. The RT-PCR results showed that AFSCs was better than NPSCs and CESCs in the aspect of the expression of adipogenic [the relative expression of peroxisome proliferator-activated receptor gamma (PPARγ) gene was 6.85±0.32 vs. 6.63±0.50 and 7.21±0.21; the relative expression of lipoprotein lipase (LPL) gene was 13.72±0.37 vs. 8.41±0.42 and 10.62±0.37] and chondrogenic [the relative expression of type 2 collagen (COL-2) gene was 10.45±1.10 vs. 3.53±0.62 and 8.26±0.49; the relative expression of sex determining region Y-box 9(SOX-9) gene was 14.39±1.22 vs. 7.66±0.68 and 13.70±1.10] differentiation-related genes, whereas the expression of osteogenic differentiation-related genes was best in CESCs[the relative expression of runt related transcription factor-2(RUNX-2) gene was 7.30±1.1 vs. 2.61±0.06 and 6.20±0.92; the relative expression of COL-2 gene was 8.22±0.84 vs. 7.05±0.82 and 4.94±0.90] and the expression of adipogentic differentiation-related genes, particularly LPL gene was worse in NPSCs. Conclusion The cell morphology was similar among NPSCs, AFSCs and CESCs in vitro, but biological characteristics of those were different. Induced differentiation and RT-PCR results both showed that AFSCs had more advantages than NPSCs and CESCs in the field of intervertebral disc tissue engineering. Key words: Intervertebral disc degeneration; Nucleus pulposus stem cells; Annulus fibrosus stem cells; Cartilaginous endplate stem cells; Biological characteristics

Osteogenic ability study on co-culture of adipose-derived mesenchymal stem cells and bone marrow mesenchymal stem cells

Objective To assess the osteogenic ability after co-culture BMSC and ADSC in vivo and in vitro. Methods ADSC and BMSC were obtained by adherent screening method and enzymatic digestion method. Flow cytometry was used to confirm the phenotypes of ADSC and BMSC. Oil red O was used to induce MSC to fat. Alkaline phosphatase (ALP) and alizarin red staining were used in osteogenic group. This sample was divided into four groups, no-induced stem cells group; BMSC osteogenic induction group; ADSC osteogenic induction group; co-culture of BMSC and ADSC osteogenic induction group. ALP activities and Calcium absorbance were determined during different periods of osteogenic introduction. OCN and Runx2 expression level were tested via RT-PCR and western blot methods after osteogenic induction for 2 weeks. Furthermore, cells in each group were seeded on HA/CS/PLLA composite scaffolds, and the scaffolds with cells were planted into bone defects in rat models. The rats were sacrificed by overdose anesthesia at 8 weeks after surgery and the scaffolds were removed for further analysis. Results Oil red O staining demonstrated red after adipogenic induction. Alkaline phosphatase and Alizarin red staining showed flaky red under condition of osteogenic induction. There had no statistical change among each group after osteogenic induction for 3 days, and ALP activity significantly increased after osteogenic induction for 5 days. Meanwhile, the ALP activity in co-culture of BMSC and ADSC group was markedly higher than the other three groups. However, there had no significant change in A value of calcium absorbance among each group after osteogenic induction for 7 days, while it increased at 14th day and ALP activity in co-culture of BMSC and ADSC group was significantly higher than the other three groups. After osteogenic induction for 2 weeks, the mRNA expression of OCN and Runx2 in co-culture of BMSC and ADSC group was 78.24±8.11 and 1 180.13±121.16 respectively, and the protein expression of OCN and Runx2 was 6.54±0.59 and 4.43±0.51. These mRNA and protein expression level in co-culture of BMSC and ADSC group enhanced significant compared with the other 3 groups. Histological assay demonstrated that the new bone tissues formed in co-culture of BMSC and ADSC group were 497.75±7.44 μm2, which was larger than that in the other 3 groups at 8 weeks after implantation. Conclusion Co-culture BMSC and ADSC may up-regulated the osteogenic ability in vivo and in vitro. Key words: Mesenchymal stem cells; Bone marrow; Adipose tissue; Coculture techniques; Tissue engineering

Rapamycin attenuates palmitate-induced lipid aggregation by up-regulating sirt-1 signaling in AML12 hepatocytes.

Rapamycin (Rap), a specific inhibitor of the mTOR signaling, has been shown to affect lipid metabolism in vitro and in vivo. Sirt-1, an NAD+ dependent deacetylase, regulates a variety of cellular processes, including aging, lifespan extension and glucose and lipid metabolism. Herein, we applied a cellular steatosis model to investigate whether rapamycin's role in lipid metabolism is sirt 1-associated. Cells were exposed to palmitate stimulation for 48 h with or without rapamycin treatment. Lipid droplets in AML12 cells were observed by oil red O staining, and the intracellular lipid content was measured. We found that rapamycin treatment, at a relatively low concentration, significantly attenuated lipid aggregation, whereas knockdown of sirt-1 by siRNA abrogated rapamycin's effect on ameliorating lipid accumulation. Moreover, rapamycin exposure increased the expression levels of sirt-1 and AMPK, and enhanced sirt-1 deacetylase activity in steatotic AML12 hepatocytes. This is the first report demonstrating that rapamycin ameliorates lipid accumulation through upregulating sirt-1 signaling supporting the hypothesis that rapamycin may positively influence sirt-1 signaling in maintaining metabolic homeostasis.

Influence of vitamin D on proliferation and differentiation of human preadipocytes in high-glucose condition

Objective To investigate the influence of 1, 25(OH)2D3(VD3) on proliferation and differentiation of human preadipocytes in high-glucose condition. Methods Primary culture of human preadipocytes were divided into 4 groups: the control group, high glucose group, control+ VD3 group, and high glucose+ VD3 group. Oil red O staining and extraction with isopropyl alcohol were employed to detect the total amount of fat in different groups. Real-time polymerase chain reaction was used to detect the mRNA levels of vitamin D receptor (VDR), CCAAT/enhancer binding protein a (C/EBPa) and peroxisome proliferator activated receptor gamma (PPARγ) in each group. Results Compared with the control group, the fat amount was significantly increased in the high glucose group(0.231±0.033 vs. 0.362±0.045, P=0.037) and high glucose+ VD3 group(0.231±0.033 vs. 0.358±0.057, P=0.033), decreased in the control+ VD3 group(0.231±0.033 vs. 0.174±0.029, P=0.016), but no significant difference in the glucose+ VD3 group(0.362±0.045 vs. 0.358±0.057, P=0.450); VDR mRNA level was decreased in the high glucose group(0.397±0.029 vs. 0.069±0.003, P=0.022), but VD3 increased the VDR mRNA levels in both the control+ VD3 group and the high glucose+ VD3 group(0.397±0.029 vs. 1.103±0.044, P=0.035; 0.069±0.003 vs. 0.152±0.021, P=0.041); the mRNA levels of C/EBPa and PPARγ were up-regulated in the high glucose group(0.135±0.048 vs. 0.788±0.063, P=0.018; 0.498±0.026 vs. 0.795±0.037, P=0.021), VD3 decreased the PPARγ mRNA level in the control+ VD3 group(0.498±0.026 vs. 0.237±0.011, P=0.029), but had no significant effect on C/EBPa mRNA(0.788±0.063 vs. 0.843±0.049, P>0.05) and PPARγ mRNA(0.795±0.037 vs. 0.813±0.041, P>0.05) expressions in the high glucose+ VD3 group or C/EBPa mRNA in the control+ VD3 group(0.135±0.048 vs. 0.156±0.022, P>0.05). Conclusion VD3 may lose the ability to inhibit the proliferation and differentiation of human preadipocyte due to reduced biological activity when exposed to high-glucose environment in vitro. Key words: Vitamin D; Vitamin D receptor; Obesity; Diabetes mellitus

First And Second-Generation Cryoballoon Ablation Efficacy Restoring And Maintaining Sinus Rhythm In Patients Electrically Selected And Treated For Long-Standing Persistent Atrial Fibrillation After Acute Complete Electrical Disconnection Of Pulmonary Veins From The Left Atrium Demonstrated.

Introduction Cryoballoon ablation (CB) has proven effective to treatment of patients (pts) with atrial fibrillation (AF). However, the isolated efficacy of CB to treat pts with long-standing persistent atrial fibrillation (LSPAF) is less know. We analyzed the acute results and the long-term follow-up of our pts suffering LSPAF and initially treated with CB. Methods A cohort of 44 pts, 37 male (84%) mean age (60±10 year) suffering LSPAF were treated with first (CB1): 15pts, and second (CB2): 29 pts, generation CB. Eight pts (18.1%) had structural heart disease. Prior to CB, all pts were previously electrically cardioverted (CV) and sinus node and A-V nodal function evaluated at electrophysiological study (EP) once in sinus rhythm (SR) before antiarrhythmic drugs (AAD) load. CB ablation procedure was performed after three months waiting period on AAD following CV/EP drug testing. Result CB procedure was performed in 27 (61.4%) in AF, restoring SR in 8 (18.2%). PV isolation (PVI) was achieved in 95.2%. On follow-up of 30±39 months, 16 pts (40%) had AF recurrence. Second procedure (Redo) was performed in 7 pts. After a single procedure, 24 pts (60%) remain in SR without AAD, after Redo, 29 pts (72.5%), and when AAD added, 31 pts (77.5%) remain in SR. Phrenic nerve palsy (PNP) occurred in 9% of pts (75% with CB2). Conclusion CB technique is safe and useful tool to treat pts with LSPAF with 60% success rate maintaining SR without AAD in a long-term follow-up (30±39 months), up to 72.5% after Redo, and to 77.5% when AAD are added. In the majority of pts maintaining SR (77.5%) CB2 was used in 87% of the cases. Patients without structural heart disease along with those who SR was restored during CB showed the best result.

Mitral Prosthetic Valve Obstruction and Its Complications

Prosthetic Valve Obstruction (PVO) is a serious complication which is associated with increased morbidity and mortality. This could result from thrombus formation, development of pannus, or a combination of both. Patients with this complication often present with symptoms and signs of heart failure, systemic embolism, acute cardiovascular collapse, and sudden death. Transesophageal echocardiography and cine fluoroscopy play a vital role in diagnosis of this potentially lethal condition. Herein, we reported a 56-year-old male patient who presented with severe heart failure and was found to have obstructed ATS27 bileaflet mitral prosthetic valve. Thrombolysis and redo surgery are two important options for treating this condition although guidelines for choosing between the two are not very definite.

The influence of IGF2BP3 on lipid metabolism in L-O2 fatty liver cell

To explore the role and mechanism of insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3) formed in non-alcoholic fatty liver disease. By using oleic acid stimulation L-O2 to induce fatty liver model, we observe the changes of relevant biochemical indexes by interference of IGF2BP3 gene expression, to investigate the change of the formation of lipid droplets through oil red O staining. Compared with control cells, in fatty liver cell model group, IGF2BP3 expression level increased significantly (P<0.05). As to the biochemical indicators: alanine transaminase (ALT), aspertate aminotransferase (AST), triglycerides, and tumor necrosis factor-α, interleukin 6 levels were significantly increased (all P<0.05). But, after interference of IGF2BP3 gene expression, ALT, AST, triglycerides, tumor necrosis factor-α, and interleukin 6 levels were significantly decreased (all P<0.05). Fatty droplet formation infatty liver cells were dramatically improved. IGF2BP3 may participate in the formation and development of non-alcoholic fatty liver disease.(Chin J Endocrinol Metab, 2015, 31: 1060-1063) Key words: IGF2BP3; Non-alcoholic fatty liver disease; Interference

Redo surgery in Hirschsprung's disease for postoperative distension and constipation

To summarize the reason and treatment of redo surgery in Hirschsprung disease for postoperative distension and constipation. From January to December 2014, 35 patients with constipation and distention after pull-through done elsewhere were referred to our institution. The reasons procedures and outcomes of redo surgery were a retrospectively analyzed. The indication of reoperation in 21 cases was pathological problems, including residual aganglionosis, retained transition zone bowel, and in 13 cases was anatomical problems, including retained dilated segment, obstructive Soave cuff. One case had both pathological and anatomical problems. Among them, 5 cases belonged to total colonic aganglionosis. All the cases received conservative treatment for about 6 months before reoperation. Five cases had enterostomy before redo pull through surgery. Thirty cases underwent Soave surgery with or without laparoscopy or laparotomy. Twenty-six cases underwent transabdominal Soave surgery, 3 cases transanal Soave surgery, 1 case transanal Soave surgery with laparoscopy. Other surgery included Ikeda surgery, excision of diaphragm or scar, and anoplasty. Postoperative complications were found in 3 patients. One had rectovesical fistula and was cured after operation. Two cases had anastomotic leakage and then underwent diverting ileostomy. Thirty-three cases had a mean follow-up of 59 months. During the follow-up, 32 cases had no distension and constipation. Two cases presented occasional dirty pants, 2 cases frequent soiling, 1 case daily soiling. Reasons of distension and constipation in Hirschsprung's disease after surgery are pathological and anatomical problems. Operation procedure is chosen based on reasons. Transabdominal Soave surgery is safe and effective.

Immunomodulatory effects of Lactobacillus rhamnosus Gorbach Goldin on alcoholic liver injury

Objective To study the effects of Lactobacillus rhamnosus Gorbach Goldin (LGG) on the balance of regulatory cell (Treg)/T helper cell 17 (Th17) and the expression changes of Toll-like receptor (TLR) signaling pathway in alcoholic liver injury. Methods After an acclimatizing period, 10-week male C57/BL6 mice were randomized into control group, alcohol group and treatment group with six mice in each group. The mice in alcohol group were fed with 5% alcohol-containing Lieber-DeCarli diet for 10 days, followed by gavage of a single dose of 40% alcohol at 5g/kg by weight. The mice in control group were pair-fed the control isocaloric diets in which ethanol was replaced with maltose-dextrin; the mice in treatment group were given LGG in the liquid diet in which one mouse consumed 1 mL/d LGG. Blood and tissue samples were collected for stained with hematoxylin-eosin (HE) or Oil red O. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected. mRNA levels of ZO-1, claudin-1, and ccluding were analyzed by real-time polymerase chain reaction (RT-PCR). The expressions of TLR4, myeloid differentiation factor 88 (MyD88), interleukin-1 receptor-associated kinase-1 (IRAK-1), nuclear factor (NF)-κB, and tumor necrosis factor (TNF)-α were analyzed by Western blot. Flow cytometry was used to analyze the balance of Treg/Th17 cells in the spleen. One-way analysis of variance (ANOVA) and multiple comparison analysis were performed for multi-groups comparison. Results Compared with control group, HE and Oil red O staining demonstrated that LGG supplementation significantly reduced the number of lipid droplets. Serum ALT and AST levels in alcohol group ([147.0±42.1] U/L and [373.5±169.7] U/L, respectively) were more elevated than control group ([56.8±15.3] U/L and [211.5±57.8] U/L, respectively), and LGG supplementation decreased the serum levels of ALT and AST ([75.3±150.2] U/L and [211.7±36.3] U/L, respectively) with statistical significant difference (F=19.474 and 4.702, respectively; P=0.000 and 0.026, respectively). The mRNA expression of tight junction proteins including ZO-1, ccluding and claudin-1 were significantly decreased by alcohol feeding, which were reversed by LGG supplementation (F=149.219, 145.561 and 154.237, respectively; all P=0.000). The hepatic protein level of Escherichia coli in the LGG supplementation group was decreased compared with alcohol group (F=130.317, P=0.000). The expressions of critical proteins such as TLR4, MyD88, IRAK-1, NF-κB, and TNF-α in the TLR4 signaling pathway in alcohol group were higher than the control group. The changes were reversed by the supplementation of LGG. The number of Treg was decreased by alcohol exposure, which was ameliorated by the supplementation of LGG administration. The number of Th17 was increased by alcohol exposure, while supplementation of LGG administration decreased Th17 counts. Conclusion LGG is effective in protecting alcohol-induced hepatic injury, by balancing Treg/Th17 and inhibiting the upregulation of TLR4 signaling pathway, which could be a potential therapeutic target in alcohol liver disease. Key words: Lactobacillus rhamnosus; Liver diseases, alcoholic; Toll-like receptors; T-lymphocytes, regulatory; Th17 cells