Cefoperazone/sulbactam-induced hemolytic anemia.

Drug-induced hemolytic anemia (DIHA) is a rare complication of drug therapy and usually underdiagnosed. Cefoperazone/sulbactam is a compound prepared from the third generation of cephalosporin and ß-lactamase inhibitor. There are limited data of DIHA induced from cefoperazone/sulbactam. A 93-year-old female patient, who had an operation on the biliary tract 3 months ago, was admitted to our hospital with an abdominal infection. After cefoperazone/sulbactam was given as anti-infection treatment, the patient developed hemolytic anemia on the third day. Cefoperazone/sulbactam was discontinued and replaced with meropenem. Subsequently the level of red blood cells, hemoglobin, and hematocrit returned to normal. Clinicians should pay attention to monitoring the possible adverse reactions during the use of cefoperazone/sulbactam and should be aware of the occurrence of DIHA, so as to give timely treatment.

[Evaluation of papilledema and visual improvement in patients with idiopathic intracranial hypertension after venous sinus stenting].

Objective: To evaluate the improvement of papilledema and visual acuities in patients with idiopathic intracranial hypertension (IIH) after venous sinus stenting. Methods: The clinical data of 8 IIH patients who met the inclusion criteria underwent venous sinus stenting between January 2013 and December 2016 at Department of Neurosurgery, Tianjin Huanhu Hospital were analyzed retrospectively. There were 6 females and 3 males,aged (32.9±14.4)years (range:19 to 57 years).The thickness of the retinal nerve fiber layer (RNFL) was measured by optical coherence tomography. Fundus,visual acuity and visual field examination were performed before and after operation. If pressure gradient ≥10 mmHg(1 mmHg=0.133 kPa) across the venous stenosis was indicated by intraoperative pressure measurement,the patient would be treated with venous sinus stenting. Intracranial pressure was measured by lumbar puncture 3 to 7 days after operation. RNFL thickness and eye examination were detected 6 months after surgery. CT venogram was used to observe the sinus venous conditions. Paired t test was used to compare the data before and after surgery. Results: All the 8 patients underwent venous sinus stenting successfully. The mean pressure gradient across the venous stenosis was reduced from (24±9.2) mmHg to (2.6±2.0) mmHg (t=8.02,P<0.01). Intracranial pressure decreased from preoperative (41.4±12.7) cmH2O(1 cmH2O=0.098 kPa) to postoperative (12.9±3.3) cmH2O (t=7.08, P<0.01). The RNFL thickness decreased from (275.3±68.3)µm to (131.4±31.8)µm(t=5.80,P<0.05) 6 months after surgery and the baseline visual acuity was improved from(M(QR))0.24 (0.25) to 0.65 (0.23)(Z=-2.52,P<0.05).Papilledema was significantly improved in 6 patients,and no significant change in 2 patients. CT venogram indicated adjacent stent restenosis in 1 patient. Conclusion: Venous sinus stenting can effectively improve papilledema and visual acuity caused by IIH.

[Clinical observation of three-dimensional printing donor tooth model in peri-operative period of autotransplantation of tooth].

Objective: To prepare a three-dimensional (3D) printing donor tooth model and to observe its application in the peri-operative period. Methods: In part one, 192 cases (2017.9-2019.8) from Department of Oral & Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University ï¼»107 males and 85 females, age (34.2±10.7) yearsï¼½ which need autotransplantation of teeth (ATT) were collected. Whether the donor teeth can be completely extracted was predicted through clinical and imaging examination (first prediction). The second prediction was supplemented by the three-dimensional printing model of the donor teeth. Each of the prediction was compared with the actual results and the coincidence rate was calculated. In part two, 64 cases (2017.9-2019.8) from Department of Oral & Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University ï¼»28 males, 36 females, age (30.2±8.3) yearsï¼½ which need ATT were randomly divided into the model group and the donor group. The time of alveolar fossa preparation, time of donor tooth in vitro, times of trial implantation and time of pulptomy and root canal location were recorded respectively. Results: In part one, the coincidence rate between the second prediction and the actual results ï¼»97.4%(187/192)ï¼½ was significantly higher than that of the first prediction ï¼»93.2%(179/192)ï¼½ (P<0.05). In part two, the preparation time of the alveolar fossa in the maxillary and mandibular were (18.8±4.6) and (22.7±3.4) min, the time of the teeth in vitro were (3.0±0.6) and (2.1±0.6) min, the times of trial implantation were (1.3±0.8) and (1.0±0.9), and the time of pulpotomy and root canal location were (4.3±0.6) and (4.0±0.5) min. All values in the model groups were better than those in the donor group (P<0.05). Conclusions: The 3D printing model is accurate. It can be used in autogenous tooth transplantation to shorten the preparation time of alveolar fossa and time of donor tooth in vitro, and reduce the times of trial implantation of donor teeth, and to help to improve the prediction accuracy of complete extraction of donor teeth and the time of pulpotomy and root canal location.

[Diagnosis and treatment planning of traumatic dental injury].

Traumatic dental injury (TDI), one of the common dental diseases, is defined as acute injuries to tooth hard tissues, dental pulp and/or periodontal tissues caused by sudden forces. Based on the Guidelines for the Management of TDI by International Association of Dental Traumatology (2012) and the Recommended Guidelines of the American Association of Endodontists for the Treatment of TDI (2013) for the permanent teeth, and combined with the authors' clinical experiences, the contemporary classification and clinical perspective of TDI were introduced in detail. Dental clinicians should understand and master the international guidelines for the management of TDI, including proper diagnosis, standardized treatments and regular follow-up, so as to obtain the favorable outcomes.

[Clinical consideration and strategy on endodontic microsurgery].

Root canal therapy is the most widely used method to treat the teeth with pulpal and periapical disorders. However, due to the complexity of root canal system, the existence of extraradicular biofilms and occurrence of true cyst, some teeth with pulpal and periapical diseases couldn't be treated effectively by non-surgical therapies. Then the combination of the surgical treatment, i.e., endodontic surgery, is necessary. The endodontic microsurgery, under the magnification and illumination provided by the dental operation microscope and with the proper use of micro instruments, ultrasonic retrotips and bioceramics root end filling materials, can treat the teeth with pulpal or periapical disorders precisely and less traumatically with high success rate. This article reviews the indications, contraindications, clinical strategy and latest advancement in endodontic microsurgery.

Overexpression of long noncoding RNA HOXC13-AS and its prognostic significance in hepatocellular carcinoma.

OBJECTIVE: The long noncoding RNA HOXC13 antisense RNA (HOXC13-AS) was overexpressed in several tumor specimens, and its overexpression was correlated with cells metastasis of tumors. However, its effects in other tumors remained largely unclear. In this work, we aimed to identify whether HOXC13-AS was abnormally expressed in hepatocellular carcinoma (HCC) and further explore its prognostic value. PATIENTS AND METHODS: QRT-PCR was applied for the examination of HOXC13-AS levels in 197 paired HCC specimens and matched non-tumor specimens. Chi-square tests were carried out for the verification of the relations between the levels of HOXC13-AS and the clinicopathologic features of HCC patients. The Kaplan-Meier methods were applied for the exploration of the prognostic value of HOXC13-AS. Multivariate analysis was performed using the Cox proportional hazard assays. RESULTS: Up-regulation of HOXC13-AS was observed in HCC tissues compared to matched normal tissues (p < 0.01). Higher levels of HOXC13-AS were associated with TNM stage (p = 0.024) and lymph node metastasis (p = 0.043). Survival assays showed that HCC patients with high-HOXC13-AS expressions had significantly shorter overall survival (p < 0.0106) and disease-free survival (p < 0.0066) compared to their counterparts with low-HOXC13-AS expressions. Multivariate analyses suggested HOXC13-AS as an independent prognostic factor for HCC patients. CONCLUSIONS: We showed that HOXC13-AS might serve as a promising biomarker for prognosis prediction of HCC.

The value of detecting pepsinogen and gastrin-17 levels in serum for pre-cancerous lesion screening in gastric cancer.

The aim of the study was to estimate the value of detecting pepsinogen (PG) I, PGII, and gastrin-17 (G-17) levels in serum for chronic atrophic gastritis (CAG) screening and to determine the clinical applicability of combined measurement of serum G-17, pepsinogens (PGI, PGII) and PGI/PGII ratio (PGR) as a screening test for CAG. The PGI, PGII, and G-17 levels were detected by ELISA in 68 patients with CAG and 86 healthy volunteers who underwent gastroscopy for gastroduodenal diseases at Taizhou Municipal Hospital between January 2016 and December 2016. Concentrations of all measured serum markers were lower in patients with CAG in comparison to healthy volunteers and achieved statistical significance (P<0.01) in PGI (93.25 vs 126.98) and PGR (12.67 vs 17.09). Receiver operating characteristic (ROC) curve analysis revealed the optimal cut-off values for PGI, PGII, PGR, and G-17 at 98.10 µg/l, 6.92 ng/l, 15.77 and 1.94 pmol/l, with sensitivities of 72.10%, 58.10%, 61.60%, and 59.30% and specificities of 61.8%, 51.50%, 77.90%, and 55.90%, respectively. The areas under the curve (AUCs) of PGI, PGR, and G-17 were 0.728, 0.726, and 0.556, respectively. The increase of AUC was observed only in PGR and G-17 combination (0.741) with increased sensitivity (69.10% vs 61.60%) of screening for CAG, whereas the specificity was reduced (72.10% vs 77.90%) in comparison to PGR alone. Combination of serum indicators can raise the diagnosis accuracy of CAG in some respects. However, further research including a larger sample size is necessary in order to accurately determine the sensitivity and specificity of combined detection of serum indicators.

Assessment of the effect of the Aquamantys® system on local recurrence after hepatectomy for hepatocellular carcinoma through propensity score matching.

OBJECTIVE: To assess the effect of the intraoperative application of the Aquamantys® system to treat the hepatic resection margin on local and overall recurrence of HCC. METHODS: We retrospectively analyzed 101 patients admitted from November 2016 to June 2018 who underwent hepatectomy using the Aquamantys® as hemostatic device, who were matched with 101 patients (control group) using conventional hemostatic devices through PSM. Univariate and multivariate analyses of recurrence-free survival (RFS) and local recurrence-free survival (LRFS) were performed using the Cox proportional hazard model. RESULTS: There were no significant differences in baseline data and surgical procedures between the two groups. The Aquamantys® group showed less blood loss (P = 0.005) and a lower blood transfusion rate (P = 0.036), while the incidences of postoperative complications of the two groups showed no difference (P = 0.266). OS rates of the Aquamantys® group and the control group were 82.6% and 84.2%, respectively (P = 0. 446), and RFS rates were 65.5% and 58.2%, respectively (P = 0.153), with no significant differences. The Aquamantys® group and the control group had two cases and 11 cases of local recurrence, respectively, with LRFS rates of 98% and 87.9%, respectively, in the follow-up period, corresponding to a significant difference (P = 0.011). Multivariate analysis showed that microvascular invasion (MVI), tumor diameter > 5 cm, and the control group were independent risk factors for LRFS. CONCLUSION: Our results indicate that application of the Aquamantys® system in hepatectomy can reduce local recurrence, but it can neither reduce overall recurrence nor improve OS.