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Objective:To explore the correlation between the characteristics of contrast-enhanced sonography of intraoperative glioblastoma multiform (GBM) and molecular markers of isocitrate dehydrogenase-1(IDH1).Methods:A retrospective analysis were performed in 30 patients who underwent neurosurgery and pathologically confirmed to be GBM at Beijing Tiantan Hospital from May 2018 to April 2019. All neurosurgical glioblastoma patients after craniotomy underwent conventional ultrasound and contrast-enhanced ultrasound(CEUS) guided navigation. The characteristics of the ultrasound imaging (whether the tumor involves the structure of the corpus callosum, the clarity of the tumor boundary after enhanced ultrasound and whether the tumor has necrotic areas with enhanced ultrasound images) were analyzed. The ratio between tumor necrosis area and whole tumor area (N/W) was measured, and the correlation with IDH1 gene expression was analyzed.Results:There were statistical differences in clarity of tumor boundary after CEUS and tumor necrosis after CEUS between positive IDH1 and negative IDH1 groups(all P<0.05). The positive expression of IDH1 was negatively correlated with the N/W area of the contrast-enhanced ultrasound mode( r=-0.756, P<0.05), suggesting that the expression level of IDH1 gene was negatively correlated with the area of tumor necrosis. Conclusions:Ultrasound contrast agent examination can more accurately distinguish the active proliferation area, hemorrhagic necrosis area and peripheral edema area of glioblastoma. Accurately identifying the extent of tumor necrosis area through ultrasound contrast agent examination can predict expression of IDH1.
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Objective To compare the safety and effectiveness of endoscopic retrograde biliary drainage ( ERBD ) and endoscopic nasobiliary drainage ( ENBD ) in treatment of acute cholangitis. Methods A retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography ( ERCP ) in Beijing Chaoyang Hospital from January 2009 to June 2017. Patients were divided into ERBD group ( n=143) and ENBD group ( n=129) according to the drainage measures. In the ERBD group, there were 63 cases of gradeⅠ(mild) acute cholangitis, 51 of grade Ⅱ ( moderate) , and 29 of grade Ⅲ ( severe) , and the corresponding cases in the ENBD group were 54, 37 and 38, respectively. The rate of improvement of inflammation, ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade. Results The rates of improvement of inflammation in the ERBD group and the ENBD group were 89. 5％ (128/143) and 94. 6％ (122/129), respectively, in overall patients (χ2=2. 399, P=0. 126), 93. 7％ (59/63) and 98. 1％ (53/54), respectively, in grade Ⅰ patients (χ2 =0. 548, P=0. 459), 90. 2％ (46/51) and 94. 6％ (35/37), respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 79. 3％ (23/29) and 89. 5％ (34/38), respectively, in grade Ⅲ patients (χ2=0. 657, P=0. 418). The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11. 9％ ( 17/143) and 7. 8％ ( 10/129) , respectively, in overall patients (χ2=1. 298, P=0. 225) , 9. 5％ ( 6/63) and 7. 4％( 4/54) , respectively, in grade Ⅰ patients (χ2=0. 006, P=0. 939) , 13. 7％ ( 7/51) and 8. 1％ ( 3/37) , respectively, in grade Ⅱ patients (χ2=0. 230, P=0. 632), and 13. 8％ (4/29) and 7. 9％ (3/38), respectively, in grade Ⅲ patients (χ2=0. 144, P=0. 705) . There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups. The incidences of interventions to drainage in the ERBD group and the ENBD group were 10. 5％ ( 15/143 ) and 3. 1％(4/129), respectively, in overall patients (χ2=5. 699, P=0. 017), 6. 3％ (4/63) and 1. 9％ (1/54), respectively, in grade Ⅰ patients (χ2 = 0. 548, P = 0. 495 ) , 9. 8％ ( 5/51 ) and 5. 4％ ( 2/37 ) , respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 20. 7％ (6/29) and 2. 6％ (1/38), respectively, in grade Ⅲ patients (χ2 = 3. 965, P= 0. 046 ) . There were significant differences in the incidence of interventions to drainage between the two groups in overall and gradeⅢpatents. Conclusion ERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis, but ENBD can reduce the incidence of interventions to drainage.
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Objective To observe the feasibility in neurosurgical brain tumor resection using ultrasound fusion navigation technology . Methods Thirty patients undergoing brain tumor rescetion accepted fusion ultrasound ( US ) navigation with magnetic renounce/computed tomography ( MR/CT ) technique and cognitive fusion" by neurosurgeon based on the tumor′s localization of magnetic renounce imaging (MRI) separately to definite the position and size of the craniotomy window flaps . After removal cranial bone ,conventional B-mode ultrasound scanning was used to detect lesion firstly . Then ,fusion US/MR navigation was applied again after automatically registration;the images of tumors from B-mode ultrasound and contrast-enhanced ultrasound separately were compared to those from coplanar reconstructive MR/CT in a real time . Results Fusion US/MR navigation was useful to define the position and size of the craniotomy window flaps ,and tumors in all patients were fully exposed to the microscope field of view . In all of 30 cases ,26 cases of fusion imaging of volume navigation technology were successfully registrated . The tumors in 3 cases of glioma ( WHO Ⅰ - Ⅱ grade) and 1 patient with pathologically verified inflammatory couldn′t be localized by conventional B-mode ultrasound but could be accurately localized after fusion ( US/MR) imaging navigation . Compared to contrast-enhanced MR ,high-grade glioma with contrast-enhanced ultrasound (CEUS) showed enhancement in arterial phase and clear tumor boundary rapidly . The enhanced modality with CEUS and MR was functioned equal . Low-grade glioma with CEUS showed scattered point or linear enhancement in arterial phase and the tumor′s margin was blurred . The preoperative T1-weighted enhanced MRI demonstrated no enhancement in the low-grade glioma . Conclusions Fusion ultrasound navigation can be used to definite size of bone flap before craniotomy . It is more suitable for fusion with preoperative T 2 Flair phase to localize low grade glioma . High-grade glioma is suitable to preoperative T 1 weighted enhanced phase for discerning margin of tumor .
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Objective:To evaluate the therapeutic effects of sinomenine on T-helper cell type 1-mediated experimental colitis in-duced by 2,4,6-trinitrobenzene sulfonic acid (TNBS) in mice. Methods:Balb/c mice were divided into five groups:ethanol control group, TNBS model group, and sinomenine treatment groups (50, 100 and 200 mg·kg-1 ) with 10 ones in each. Colitis was induced by colonic instillation of TNBS dissolved in 0. 1 ml of 50% ethanol. Seven days after the colonic instillation of TNBS, sinomenine was given by gastric gavage once daily for 21 days. The mice were sacrificed on the 28th day, the injury degree of colonic mucosa was ob-served, the colon myeloperoxidase ( MPO) activity was determined, and the levels of inflammatory cytokines ( TNF-α, IL-17 and IL-23) were determined by ELISA. Results:Compared with those in TNBS model group, the body mass, gross injury score and histologi-cal findings in sinomenine groups at medium dose and high dose were significantly improved (P<0. 05), the activity of MPO signifi-cantly decreased (P<0. 05), and the protein levels of TNF-α, IL-17 and IL-23 in colonic mucosa were lower than those in TNBS group (P<0. 05). Conclusion:Sinomenine has notable therapeutic effect on TNBS-induced chronic colitis in mice, and the mecha-nism is related to the inhibition of Th1 cytokines by sinomenine.
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OBJECTIVE:To provide reference for rational use of antibiotics in terminal stage patients with malignant tumor. METHODS:The inpatients with malignant tumor who died in the department of medical oncology of our hospital from Mar. 2013 to Mar. 2016 were analyzed retrospectively in respects of general situation,infection situation and antibiotics use. RESULTS:Among 149 inpatients,a total of 129 infection cases were found in 113 patients(75.8%). The most frequent sites of infection were lung(65.9%),followed by digestive tract/abdomen(13.2%),and skin/wound(6.2%). 100 patients (67.1%)received antibiot-ics,61.1% of which were empiric treatment. β-lactam/β-lactam lactamase inhibitor(41.8%),fluoroquinolone(21.7%)and cepha-losporin(16.9%)were the top 3 frequently prescribed antibiotics. The effective rate of antibiotics treatment was as low as 15.8%, which was believed to be linked with the survival duration since infection occurred (P<0.001),the Karnofsky performance scale (KPS)score when infection occurred(P<0.001)and the duration of antibiotics treatment(P=0.025). CONCLUSIONS:Terminal stage patients with malignant tumor are vulnerable to infections,especially to pulmonary infection. The empirical broad-spectrum an-tibiotics are widely used in terminal patients with malignant tumor,but the effectiveness rate of antibiotic treatment is in low level. For those terminal stage patients with malignant tumor and with KPS score<60 points,when futile antibiotics treatment last for more than 7 days,timely termination of antibiotics treatment is a better choice.
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Objective To establish a liquid chromatographic-mass spectrometric method ( LC-MS/MS method ) for determination of dextrorphan in human liver microsome. Methods LC-MS/MS was adopted with carbamazepine serving as an internal standard.The separation was performed on Agilent ZORBAX XDB-C18 column (2.1 mm×50 mm, 3.5μm), with mobile phase consisting of 0. 05% formic acid methanol-0. 05% formic acid in gradient elution. Dextrorphan and carbamazepine were detected on multiple reaction monitoring(MRM)mode by transitions from precursor to production(m/z 258.1→199.1, 237.1→194.1). Results The linear range of dextrorphan concentration was 19.22-768 960 ng.L-1(r=0.999 8), and the lowest quantification limit was 19.22 ng.L-1.The relative recoveries were 94.02%-98.74%, and the RSDs of intra-day and inter-day were within 10%.IC50 of psoralen on CYP2D6 was 0.6μmol.L-1. Conclusion The LC-MS/MS method is proved to be rapid, sensitive and reproducible, psoralen is a strong inhibitor of CYP2D6.
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OBJECTIVE:To explore the role of clinical pharmacist in the therapy for patient with community-acquired Pseudo-monas aeruginosa lung abscess. METHODS:Clinical pharmacist participated in the therapy for a patient with community-acquired P. aeruginosa lung abscess,analyzed anti-infective therapy plan,and adjusted drug use timely to correct agranulocytosis induced by anti-infective drugs. RESULTS:The physicians adopted the suggestions of clinical pharmacists,controlled the infection successful-ly and corrected agranulocytosis. CONCLUSIONS:Community-acquired P. aeruginosa lung abscess is rare but has high mortality. Clinical pharmacists participate in drug therapy,assist physician to improve and optimize therapy plan and formulate individual medication plan so as to promote promote care rate of patients.
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Background Refractive surgery has propelled itself forward to become widely performed surgical procedure nowadays.After the surgery,corneal biomechanics decreases lead to keratoconus and corneal ectasia.Doctors pay more attention to biomechanics changes after refractive surgeries.Objective This clinical study was to investigate the influence of different laser refractive surgeries on corneal biomechanics.Methods A prospective nonrandomized and controlled clinical study was designed.One hundred and sixty-four eyes of 82 patients with moderate myopia were enrolled.The patients were divided into sub-Bowman keratomileusis (SBK) group (60 eyes of 30 patients),laser in situ keratomileusis (LASIK) group (54 eyes of 27 patients) and laser subepithelial keratomileusis (LASEK) group (50 eyes of 25 patients),with the matched demography among the three groups.Corneal hysteresis (CH) and corneal resistance factor (CRF) were detected by ocular response analyzer (ORA) before and 1 week,5 months after refractive surgery.The correlations between stromal ablation depth and postoperative changing values of CH or CRF were analyzed.Results Significant differences were found in CH and CRF at different time points in the three groups (Ftime =41.90,P =0.00;Ftime =49.65,P =0.00),and the CH and CRF values were significantly lower 1 week and 5 months after surgery than those before surgery (all at P =0.00).However,no significant difference of CH or CRF was seen at all time points among the three groups (Fgroup =2.17,P =0.08;Fsroup =2.67,P =0.07).No correlation was found between corneal ablation depth and CH in 1 week and 5 months after surgery (both at R2 =0.000),however,weaker correlations were seen between corneal ablation depth and CRF 1 week and5 months after surgery (Y=3.253+ 0.010X,R2=0.007;Y=1.073+0.021 X,R2=0.004).Conclusions SBK,LASIK and LASEK lead to the change of corneal biomechanics by altering CH and CRF,they play the same influence on cornea.CRF appears to be an useful indicator in evaluating corneal biomechanical changes after laser refractive surgery.
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Objective:To study the impact of clinical pharmacy information management system on antimicrobial stewardship in a general teaching hospital. Methods:The main function, deficiencies and aspects needing improvement of clinical pharmacy information management system, and its influence on antimicrobial stewardship were introduced. Results:The information system had such functions as antimicrobial usage statistics, evaluation of antimicrobial prescription, and the use intensity calculation of antimicrobials. By using the information system, manpower of antimicrobial stewardship was saved, antimicrobial statistics became more comprehensive and objective, and dynamic real-time monitoring of antimicrobial drugs management was realized. However, the system still had some shortcomings needing improvement. Conclusion:Clinical pharmacy information system can promote the implementation and efficiency of antimicrobial stewardship.
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Objective To explore the diagnostic value of alcohol fixation and liquid-based cytology method for malignant stricture of common bile duct and to study the interval time between sampling and fixation for procedure of alcohol fixation.Methods Data of 82 patients were retrospectively studied,who were suspected of having malignant stricture of common bile duct underwent brushing through endoscopic retrograde cholangiopancreatography (ERCP),and were confirmed by follow-up for 2 years or pathology after surgery from October 2008 to June 2013.These patients were randomly divided into alcohol fixation group (n =30),liquid-based cytology group (n =28) and conventional cytology group (n =24).The positive diagnostic rates of brush cytology in each group were compared.The alcohol fixation group were randomly divided into 2-minute group and 5-minute group according to the interval time between sampling and fixation.Positive diagnostic rates were also compared.Results The positive rates were 73.33％ (alcohol fixation group,22/30),75.00％ (liquid-based cytology group,21/28) and 20.83％ (conventional cytology group,5/24),respectively.The positive rate of conventional cytology group was obviously lower than alcohol fixation group (x2 =21.525,P=0.000) and liquid-based cytology group (x2 =22.208,P =0.000) with statistical significance.But the positive rate of alcohol fixation group was similar to the liquid-based cytology group (x2 =0.683,P =0.898).In alcohol fixation group,the positive rate of 2-min group (88.24％,15/17) was significantly higher than the 5-min group (53.85％,7/13) with statistical significance (x2 =4.535,P =0.033).Conclusion Compared with conventional fixation,alcohol fixation and liquid-based cytology can improve positive diagnostic rate of brushing during ERCP.The alcohol fixation is more simple in procedure and low in cost than liquid-based cytology.The interval time between sampling and fixation should be reduced to no more than 2 minutes.
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Objective To investigate the method of early termination of cesarean scar pregnancy (CSP).Methods Clinical data of 12 patients with CSP were retrospectively analyzed,all patients were treated with mifepristone 25mg in the morning and evening for 3 days,and misoprostol 600μg in the morning at the fourth days.Results Of 12 patients,medical abortion were completely in 4 cases,and 6 cases were failure which were carried out painless abortion with microtubules(disposable suction tube).2 cases were taken curettage because of hemorrhage after incomplete abortion.1 case was improved by massage the uterus,and intramuscular injection of oxytocin 20u in cervix;another one case was taken uterine artery embolization because of postoperative bleeding about 2 000ml with shock symptoms.Conclusion The CSP is complicated,the early prevention and treatment must be taken for it,and once it diagnosed,the termination of pregnancy should be immediately taken,in patients with a history of cesarean section line miscarriage may occur when the hard-to-control bleeding.Uterine artery embolization is an effective treatment method for the first choice.
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Objective To evaluate curative effects of treatment of malignant biliary and gastric outlet-duodenal obstruction with endoscopically placed self-expandable metal stents.Methods A retrospective analysis was performed in 17 patients who underwent enteral stenting after placement of the biliary stent.The success rate of insertion,the effective palliation of biliary and duodenal obstruction,the rate of complication,recurrent stent obstruction and the median patency were observed.Results In 17 patients,biliary stenting were all performed for obstructive jaundice and then enteral stents were inserted.The levels of tatal billirubin [from (263.4 ± 62.5) μmol/L to (157.6 ± 25.1) μmol/L],direct billirubin [from (1233.2 ±66.5) μmol/L to (130.9 ± 27.7) μmol/L] and alkaline phosphatase [from (233.2 ± 66.5) IU/L to (130.9 ±27.7)IU/L] decreased significantly (P ＜0.01),and the gastric outlet score increased significandy [from (0.9 ± 1.1) points to (2.1 ±0.7) points] (P ＜0.01).No serious complication in all patients.Lifetime of patients ranged from 70 days to 332 days,and the median survival time was 192 day.Conclusion Combined biliary and enteral stenting is an effective method for palliation of malignant biliary and gastric outlet-duodenal obstruction.
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Objective To evaluate the clinical efficacy of emergent endoscopic injection of tissue adhesive (N-oclyl-a-cyanoacrylate) combined with endoscopic variceal ligation (EVL) for esophageal and gastric varices bleeding. Methods Data of 21 patients with acute esophageal and gastric varices bleeding who received emergent endoscopic injection of tissue adhesive and EVL were retrospectively studied. Results The instant hemostatic rate was 95% (20/21) with no severe complications. Conclusion Emergent endoscopic injection of tissue adhesive combined with EVL is an effective and safe therapy for esophageal and gastric varices bleeding.
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Objective To evaluate the efficacy and feasibility of ultrasound-guided percutaneous microwave ablation for peripheral lung cancer. Methods Seventeen patients with peripheral lung cancer (23 nodules) were treated with ultrasound-guided microwave ablation. The microwave energy was initially set at 60 W for 100s, and then at 30~40 W for 300~600 s. The treatment was conducted by using multiple simultaneously-powered antennas in lesions ≥3 cm in diameter. Results After the treatment, all the nodules were decreased in size and the blood flow signals inside the nodule disappeared (14 nodules) or weakened (9 nodules). Enhanced CT scanning revealed no enhancement in 16 nodules and partial enhancement in 7. Repeated biopsy in 4 patients showed a complete tumor necrosis. Clinical symptoms disappeared in 8 patients and subsided in 9 patients 1 month after treatment. Follow-up observations in 15 patients for 6~47 months (mean, 23 months) showed 9 survivors, without serious complications. Conclusions Ultrasound-guided percutaneous microwave ablation is an effective, safe, and feasible method for treating peripheral lung cancer.
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AIM: To explore the effects of sodium ferulate (SF) on function of macrophages in colonic tissue of the colitis rats in vivo. METHODS: The immunological colitis model of rats was produced. SF was used intracolonically for 21 days. The contents of malondialdehyde (MDA), nitric oxide (NO), prostaglandin E_2 (PGE_2) and the activity of superoxide dismutase (SOD), interleukin-1 (IL-1), TNF-?, myelopexoxidase (MPO), and the expression level of NF-?B p65 in colonic tissue of the rats were detected. RESULTS: SF (200,400,800 mg/kg) decreased the elevated contents of MDA, NO, PGE_2, the activity of IL-1, TNF-?, MPO, and the expression level of NF-?B p65, while increased the reduced activity of SOD in colonic tissue of the colitis rats in a dose-depended manner. CONCLUSION: SF restrained the activity of activated colonic macrophages and relieved the colonic inflammation reaction in vivo in colitis rats, which may be related to the suppression of NF-?B activation. [
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AIM: To investigate the influences of native and oxidized lipoprotein(a) on human arterial smooth muscle cell (SMC) proliferation, change of intracellular free calcium concentration ([Ca 2+ ] i) and the protective effect of sodium ferulate(SF). METHODS: Lp(a) was oxidized by Cu 2+ and the extent of oxidation was assessed by the MDA content.Human SMC were incubated in culture media with SF for 12 h, then exposed to Lp(a) and oxidized-Lp(a), respectively. MTT colorimetry and flow cytometry were used to evaluated the proliferation of SMC and flurorescent indicator Fura-2/AM was used to determined [Ca 2+ ] i. RESULTS: ox-Lp(a) significantly promoted proliferation of SMC and increased[Ca 2+ ] i compared with Lp(a). SF(40,80 mg/L) remarkedly inhibited SMC proliferation and decreased the rising of [Ca 2+ ] i induced by ox-Lp(a) in a dose-dependent manner, but no effect on SMC proliferation and the increase in [Ca 2+ ] i induced by Lp(a).CONCLUSION: ox-Lp(a) induces the strong growth-promoting effect in SMC through increasing in [Ca 2+ ] i, which might be one of the cellular mechanisms responsible for the higher atherogenic potential of ox-Lp(a) compared with Lp(a), and this process can be prevented by inhibiting of oxidation by SF.
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AIM To investigate the anti-inflammation protective effects of sodium ferulate (SF) on colitis rats and its mechanism. METHODS The colitis model of rats was produced by intracolon enema with acetic acid. SF and 5-ASA were used intracolonically for a week. The colon mucosadamage index (CMDI) was evaluated. Nitric oxide (NO), myelopexoxidase (MPO), prostaglandin (PGE_2), and the levels of expression of constitutive nitric oxide synthase(cNOS), induce nitric oxide synthase (iNOS), cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2) and nuclear factor-kappaBp65(NF-?Bp65) in the rats colon were detected by corresponding kits and immunohistochemical technology. RESULTS SF (200,400,800 mg?kg -1 ) can decrease the extents of CMDI and the levels of NO, MPO, PGE_2, the expression of cNOS, iNOS, COX-2, and NF-?Bp65 in model group in a dose-dependent manner while the expression of COX-1 changes littlely. CONCLUSION SF is a NOS and partial selective COX-2 inhibitor and show therapeutic effect on colitis in rats.