Efficacy and safety of stereotactic body radiation therapy in treatment of patients with unresectable cholangiocarcinoma / 临床肝胆病杂志

ObjectiveTo investigate the survival and adverse reactions of patients with unresectable cholangiocarcinoma after stereotactic body radiation therapy （SBRT）. MethodsA total of 27 patients with unresectable solitary cholangiocarcinoma without metastasis who underwent SBRT in The Fifth Medical Center of Chinese PLA General Hospital from February 2012 to July 2020 were enrolled. The prescribed dose to planning target volume was 42-60 Gy in 5-8 fractions， with 5-11 Gy/fraction. Among these patients， five patients were also treated with chemotherapy and transcatheter arterial chemoembolization. The 6-， 12-， 18-， and 24-month overall survival （OS） rates， progression-free survival （PFS） rates， and local control （LC） rates were used as the assessment indices for treatment outcome； Common Terminology Criteria for Adverse Events v.4.03 was used to evaluate adverse reactions； the Kaplan-Meier method was used to calculate OS， PFS， and LC rates. ResultsThe median follow-up time was 17 months. For all 27 patients， the 6-， 12-， 18-， and 24-month OS rates were 100%， 88%， 57.5%， and 47.9%， respectively； the 6-， 12-， 18-， and 24-month PFS rates were 74.1%， 58.6%， 47.9%， and 35.9%， respectively； the 6-， 12-， 18-， and 24-month LC rates were 96.3%， 91.9%， 84.8%， and 76.4%， respectively. No grade 3 or above toxic reactions were observed. Five patients were diagnosed with radiation-induced liver injury， but there was no death due to radiation-induced liver injury. ConclusionSBRT is safe and effective in the treatment of unresectable cholangiocarcinoma， with relatively high survival rate， PFS rate， and LC rate and low toxicity， and therefore， SBRT can be used as an alternative treatment method for patients with cholangiocarcinoma who are not candidates for surgery.

Efficacy and safety of sequential lenvatinib therapy after stereotactic body radiotherapy in treatment of advanced primary liver cancer / 临床肝胆病杂志

ObjectiveTo investigate the efficacy and safety of sequential lenvatinib therapy after stereotactic body radiotherapy (SBRT) in the treatment of advanced primary liver cancer. MethodsA total of 18 patients with advanced primary liver cancer who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2018 to May 2019 were enrolled, among whom there were 4 patients with BCLC stage B liver cancer and 14 patients with BCLC stage C liver cancer. The prescribed dose of planning target volume was 48-55 Gy (median 50 Gy) in 6-9 fractions, and the median of single dose was 6 (5-9) Gy per fraction. Oral administration of lenvatinib was given since 1 week after SBRT was finished, with a median medication time of 9.5 (3.6-25.8) months. Follow-up was performed once a month for the first 3 months after treatment and once every 3 months after 3 months of treatment. The Kaplan-Meier method was used to calculate overall survival (OS) rate, progression-free survival (PFS) rate, and local control (LC) rate, and the incidence rates of adverse reactions and complications were also observed. ResultsUp to the follow-up on November 30, 2020, a total of 8 patients died, among whom 3 died of liver failure, 3 died due to tumor progression, 1 died of perforation of gallbladder, and 1 died of gastrointestinal bleeding. At 3, 6, 9, 12, and 18 months of treatment, the OS rates were 100%, 94%, 83%, 72%, and 67%, respectively, the PFS rates were 100%, 67%, 50%, 22%, and 17%, respectively, and the LC rates were 100%, 94%, 94%, 94%, and 94%, respectively; the median OS time was ＞18 months, and the median PFS time was 9 months. Of all patients, 1 (6%) had a grade 3 adverse reaction during SBRT and 2 (11%) experienced a grade 3 adverse reaction during lenvatinib treatment, and no fatal adverse reaction was observed. ConclusionIt is preliminarily proved that sequential lenvatinib therapy after SBRT is an effective and safe treatment method for advanced primary liver cancer.

Phantom study of the influence of time of flight and point spread function on PET/CT image quality and standardized uptake value / 中华核医学与分子影像杂志

Objective:To explore the influence of time of flight (TOF) and point spread function (PSF) on PET/CT image quality and standardized uptake value (SUV) based on a phantom study.Methods:PET/CT imaging were performed using Jaszczak phantom and International Electrotechnical Commission (IEC) body phantom respectively, and conventional clinical imaging protocol (3 min/bed) was used for three consecutive imaging. The ordered subsets expectation maximization (OSEM), OSEM+ TOF, OSEM+ PSF and OSEM+ TOF+ PSF were used to reconstruct the raw data respectively. The differences of image resolution, image uniformity, contrast, signal to noise ratio (SNR) and SUV among different reconstruction algorithms were compared by using one-way analysis of variance and the least significant difference (LSD) t test. The correlations between SNR, mean SUV (SUV mean), maximum SUV (SUV max) and the sphere diameter were analyzed by Pearson correlation analysis. Results:The minimum image resolution for the hot column was 6.4 mm by OSEM and OSEM+ PSF reconstruction, while it was 4.8 mm by OSEM+ TOF and OSEM+ TOF+ PSF reconstruction. The contrast was significantly better by OSEM+ TOF ((78.56±1.21)%) and OSEM+ TOF+ PSF ((78.85±1.17)%) reconstruction than that by OSEM reconstruction ((73.44±1.47)%; F=61.068, t values: 9.503, 10.018, both P<0.001). The maximum and minimum nonuniformity percentages were significantly better for images reconstructed with OSEM+ PSF than those reconstructed with OSEM ( F values: 10.286, 27.630, t values: -2.599, 7.698, both P<0.05). In IEC phantom imaging, the SNR and SUV max of hot sphere were higher by OSEM+ PSF and OSEM+ TOF+ PSF reconstruction than those by OSEM reconstruction (SNR: (98.99±34.76)%, (98.29±28.66)%, (73.64±26.05)%; F=5.712, t values: 3.209, 3.412, both P<0.05; SUV max: 8.96±2.72, 9.28±2.17, 8.01±2.21; F=3.931, t values: 2.154, 2.863, both P<0.05), but there was no significant difference between OSEM+ TOF and OSEM reconstruction ( t values: 0.297, 0.272, both P>0.05). Among the four reconstruction methods, the SNR and SUV mean increased with the increase of the sphere diameter ( r values: 0.913-0.963, all P<0.05), but SUV max in images reconstructed with OSEM+ PSF and OSEM+ TOF+ PSF had no significant correlations with the sphere diameter ( r values: 0.496, 0.614, both P>0.05). Conclusions:Under specific acquisition and reconstruction conditions, TOF mainly improves image resolution and contrast, while PSF mainly improves image uniformity and SNR. The combination of the two method can obtain better image quality and significantly improve the SUV of hot lesions.

Quantitative measurement of standardized uptake value of lumbar vertebra by 99Tcm-MDP bone imaging with SPECT/CT / 中华核医学与分子影像杂志

Objective To explore the quantitative determination of standardized uptake value(SUV)of lumbar vertebra by 99Tcm-methylene diphosphonate(MDP)bone imaging with SPECT/CT.Methods A total of 90 patients(16 males,74 females,age:(60.0±11.2)years)who underwent 99Tcm-MDP bone imaging and local lumbar SPECT/CT imaging from May 2017 to November 2017 were retrospectively analyzed.CT attenuation correction,scatter correction and 3-dimensional ordered subset expectation maximization(3D-OSEM)reconstruction were used.The radioactive counts of lumbar vertebra LL-L4 in patients with high MDP-uptake(including degenerative changes and bone metastases)and patients with non-high MDP-uptake(including osteoporosis and non-osteoporosis)were measured.Basing on that,the radioactivity of unit volume in lumbar and lesion was calculated and converted to SUV.The difference of SUV for lumbar and lesions from different types of patients was analyzed,and the correlation between lumbar SUV and varies of parameters were also analyzed.Data were analyzed by two-sample t test and Pearson correlation analysis.Results The mean SUV(SUVmean)and maximum SUV(SUVmax)of L1-L4 in 54 patients with non-high MDP-uptake were 4.64±1.03 and 7.09±1.61 respectively.They were positively correlated with bone mineral content,CT value and body weight(r values:0.433-0.700,all P<0.05),and negatively correlated with age(r values;-0.514 and -0.456,both P<0.001).The SUVmean and SUVmax of patients with osteoporosis were 3.81±0.76 and 5.86±1.34 respectively,which were significantly lower than those of non-osteoporosis(5.13±0.84 and7.82±1.30;t values:-5.892 and-5.240,both P<0.001).The SUVmean and SUVmax of 37 metastases were 16.40±6.07 and 24.25±11.35 respectively in 16 patients,which were significantly higher than those in patients with degenerative changes(20 patients with 27 lesions;9.30±3.16 and 13.48±5.21;t values:6.074 and 5.083,both P<0.001).Conclusion Based on the specific reconstruction algorithm and correction method,the SUV of lumbar vertebra on 99Tcm-MDP SPECT/CT bone imaging can be obtained,and the bone mineral metabolism can be reflected.

Correlation Analysis of ADPRT rs1136410 Polymorphism with the Occurrence of Non-small Cell Lung Cancer in Han Nationa- lity from Northern Jiangsu / 中国药房

OBJECTIVE： To investigate the correlation of ADPRT rs1136410 polymorphism with the occurrence of non-small cell lung cancer （NSCLC） in Han nationality from northern Jiangsu. METHODS： A total of 283 patients with primary NSCLC of Han nationality in Northern Jiangsu were selected from the Affiliated Hospital of Xuzhou Medical University during Nov. 2015-Dec. 2018 as NSCLC group. A total of 210 healthy subjects underwent physical examination were included in control group. PCR-RFLP was utilized to determine the genotypes at ADPRT rs1136410 locus. Logistic regression model was used to evaluate the effect of polymorphism and its interaction with smoking on the occurrence of NSCLC. RESULTS： There was no statistical significance in age and gender between 2 groups （P＞0.05）. The proportion of smoker in NSCLC group was significantly higher than control group （P＜0.05）. TT， TC and CC genotypes were detected at rs1136410 locus of ADPRT gene. The frequency of TT， TC and CC genotype were 41.9％，44.8％ and 13.3％， and those of allele T and C were 64.3％ and 35.7％ in control group. The frequency of TT， TC and CC genotype were 21.6％， 50.2％ and 28.2％， and those of allele T and C were 46.6％ and 53.4％ in NSCLC group， respectively. The frequencies of genotypes in 2 groups were in accordance with Hardy-Weinberg equilibrium （P＞0.05）， while there was significant difference in genotype and allele frequencies between 2 groups （P＜0.05）. Compared with TT genotype， the risk of NSCLC in individuals carrying TC and CC genotypes raised by 1.179， 3.122 folds [ORTC＝2.179， 95％CI （1.435， 3.309）， P＜0.05； ORCC＝4.122，95％CI（2.401，7.075），P＜0.05]. Compared with individuals carrying TT genotype， the risk of NSCLC occurrence in non-smokers carrying TC and CC genotypes increased by 0.371， 1.328 fold [ORTC＝1.371，95％CI （0.927，3.428），P＜0.05； ORCC＝2.328，95％CI （1.249，4.622），P＜0.05]； and the risk of NSCLC occurrence in smokers carrying TC and CC genotypes increased by 0.928， 2.182 folds [ORTC＝1.928，95％CI （1.257，2.957）， P＜0.05；ORCC＝3.182，95％CI （1.760，5.754）， P＜0.05]. CONCLUSIONS： The rs1136410 locus mutant genotype of ADPRT gene is the risk factor of NSCLC in Han nationality from Northern Jiangsu， and smoking raises this risk of NSCLC occurrence in individuals with mutation genotypes of ADPRT rs1136410.

Impact of different reconstruction algorithms and ordered subset expectation maximization reconstruction parameters on quantitative results in SPECT/CT / 中国医学影像技术

Objective To evaluate the impact of 3-dimensional ordered subset expectation maximization (3D-OSEM),2-dimensional ordered subset expectation maximization (2D-OSEM),filtered-back projection (FBP),and the number of OSEM iterations and subsets on quantitative results in SPECT/CT.Methods A Jaszczak cylindrical phantom and NEMA/IEC body phantom were performed in routine SPECT/CT using CT attenuation correction,scatter correction and 3D-OSEM reconstructed image.The system volume sensitivity (cpm/kBq) was acquired from the reconstructed image of Jaszczak phantom,and the absolute activity concentration (kBq/ml) of the hot sphere from IEC phantom was calculated and compared with true activity concentration,then quantitative error was calculated.With changing the reconstruction algorithm (2D-OSEM,FBP) and OSEM reconstruction parameters (number of iterations and subsets) to reconstruct the IEC phantom,the differences of quantitative results from different reconstruction algorithms and OSEM iterations and subsets were compared.Results When reconstructing images with 3D-OSEM,2D-OSEM and FBP,the quantitative error of each sphere increased with the decrease of the spherical volume (r=-0.831,-0.831,-0.826,all P＜0.05).The quantitative error of different volume spheres among three reconstruction algorithms was statistically significant (F=8.850,P＜0.05).Among them,the result of 3D-OSEM was less than that of 2D-OS EM (P＜0.05),and of 2D-OSEM was less than of FBP (P＜0.05).The quantitative error of different volume spheres decreased with the increasing of number of iterations (r=-0.721,-0.681,-0.691,-0.711,-0.845,-0.893,all P＜0.05) and decreased with the increase of number of subsets (r=-0.670,-0.694,-0.717,-0.852,-0.956,-0.998,all P＜0.05).Conclusion The quantitative accuracy of 3D-OSEM reconstruction based on CT attenuation correction and scattering correction is significantly better than that of 2D-OSEM and FBP.Choosing the appropriate OSEM reconstruction parameters is helpful to improve the quantification accuracy in SPECT/CT.

Correlation Analysis of XRCC1 rs25487 Polymorphism with the Occurrence of Lung Cancer / 中国药房

OBJECTIVE:To investigate the correlation of XRCC1 rs25487 polymorphism with the occurrence of lung cancer. METHODS:A total of 208 patients with primary lung cancer of Han nationality in Northern Jiangsu selected from the Affiliated Hospital of Xuzhou Medical University during Sept. 2015-Jul. 2016 were included in lung cancer group. A total of 214 healthy volunteers of the hospital underwent physical examination were included in control group. PCR-RFLP was used to detect the genotypes at XRCC1 rs25487 locus,and Logistic regression model was used to evaluate the correlation of genotypes with the occurrence of lung cancer. RESULTS:There was no statistical significance in the distribution of age and gender between 2 groups (P＞0.05). The proportion of smoker in lung cancer group was significantly higher than control group,with statistical significance(P＜0.05). AA,AG and GG genotypes were detected at rs25487 locus of XRCC1 gene. The frequency of AA,AG and GG genotype were 43.5%,41.1%and 15.4% in control group and 28.8%,48.6% and 22.6% in lung cancer group,respectively. The frequencies of genotypes in 2 groups were in line with Hardy-Weinberg equilibrium(P＞0.05),but there was statistical significance in genotype distribution between 2 groups(P＜0.05). Compared with AA genotype,the risk of lung cancer in individuals carrying AG genotype increased by 2.265 fold [OR＝2.265,95%CI(1.299,3.950),P＝0.040;after corrected with gender,age and smoking history OR＝2.309,95%CI(1.274, 4.185),P＝0.006],with statistical significance. The risk of lung cancer in individuals carrying GG genotype increased by 1.310 fold [OR＝1.310,95%CI(0.771,2.228),P＝0.318;after corrected OR＝1.429,95%CI(0.811,2.518),P＝0.217],without statistical significance. CONCLUSIONS:rs25487 locus mutant heterozy-gosity of XRCC1 gene is risk factor of lung cancer in Han nationality from Northern Jiangsu,and smoking can increase the risk of lung cancer.

Impact of Partial Volume Effect on Quantitative Results in SPECT/CT / 中国医学影像学杂志

Purpose The partial volume effect is a main factor to impact the image quality and the accuracy of the quantitative analysis of nuclear medicine image.The aim of this study is to evaluate the effects of partial volume effect on quantitative result in SPECT/CT.Materials and Methods A Jaszczak cylindrical phantom and IEC body phantom were performed with routine SPECT/CT imaging using CT attenuation correction,scatter correction and three-dimensional ordered subset expectation maximization (3D-OSEM) reconstruct image.The system volume sensitivity (cpm/kBq) were acquired from the reconstructed image of Jaszczak phantom study.The absolute activity concentration (kBq /ml) of the hot sphere was calculated according to the IEC phantom study that the intensity of radioactivity had been measured in the dose calibrator,then checking computations the quantitative accuracy of all.The difference of quantitative accuracies from the different volume hot sphere was compared tusing a given acquisition and reconstruction parameter.The effects of volume of interest (VOI),target-to-background ratio (TBR) and acquisition time on quantitative accuracy were evaluated.Results CT attenuation correction and scatter correction,the difference of absolute activity and true activity value was obviously correlation with the sphere size by using 3D-OSEM.The quantitative errors were decreased along with the increased of sphere size (r=-0.844,P＜0.05).The quantitative accuracy were significantly affected by the VOI size in the 1.15-11.49 ml sphere.It was obviously lower in the limbic of sphere than that in the center of sphere.And the quantitative errors were decreased along with the decreased of VOI size (r=0.999,0.992,0.994 and 0.767,P＜0.05).However,the quantitative error was no obviously correlation with the VOI size (r=0.348,0.478,P＞0.05) in the 26.52 ml and 0.52 ml sphere.The average quantitative error was lower in high TBR imaging (44.19％) than that in low TBR imaging (-46.18％),and it was lower in 20 s/frame imaging (-44.33％) than that in 10 s/frame imaging (-46.04％).Conclusion The quantitative accurate could be obviously affected by the partial volume effect in SPECT/CT imaging,exceptionally in the small lesions and the limbic of lesions.

Non-pharmacological interventions in non-alcoholic fatty liver disease patients / 中华健康管理学杂志

Patients with non-alcoholic fatty liver disease (NAFLD) have unhealthy diets, sedentary behavior and lack of physical activity. This lifestyle triggers liver disease and probably favors its progression. It is now the most common significant cause of end-stage liver disease and hepatocellular carcinoma. From the perspective of non-pharmacological intervention, lifestyle modifications including diet, exercise, and weight loss remain the most effective therapy for nonalcoholic fatty liver disease. Bariatric surgery in morbidly obese individuals who have failed to lose weight through lifestyle modifications can improve steatosis, inflammation, and fibrosis. Comprehensive treatment measures can produce synergistic effect, but long-term adherence is particularly critical.

Ethical Reflections on Medical Dispute in the Department of Otorhinolaryngology / 中国医学伦理学

In recent years, there were several extreme conflicts between doctors and patients in Otorhinolaryn-gology department. Medical field always contributes the disputes to medical system and patients′quality, however, the public blames the doctors′morality. This article analyzes these incidents in the perspective of ethics and social medicine, trying to find the causes. And it puts forward the countermeasures in terms of medical education, hospi-tal, and the medical personnel.

Therapeutic Effect of Comprehensive Traditional Chinese Medical Therapy for Regulating Spleen and Stomach in Treating Tinnitus / 广州中医药大学学报

Objective To evaluate the short-term and long-term effect of comprehensive traditional Chinese medical therapy for regulating spleen and stomach in treating tinnitus. Methods Telephone follow-up was carried out in 333 cases of qualified tinnitus outpatients and inpatients from the First Affiliated Hospital of Guangzhou University of Chinese Medicine admitted from January of 2008 to December of 2014. All of the included patients were treated by comprehensive traditional Chinese medical therapy for regulating spleen and stomach. The degree of tinnitus was evaluated by Tinnitus Effect Questionnaire(TEQ) on the first visit and the last visit and during follow-up, and then the TEQ scores were analyzed by statistical methods. Results On the first visit, the mean TEQ scores were 11.17 ± 3.11. On the last visit, the mean treatment course was 33.64 ± 37.07 days, and the mean TEQ scores were 9.57 ± 3.43; 5 cases were cured, 25 were markedly effective, 79 were effective, 224 were ineffective, and the total effective rate was 32.73%. The interval of the first follow-up to the first visit averaged 32.89 ± 8.53 months, and the mean TEQ scores were 5.35 ± 3.71 during the interval; 20 cases were cured, 21 were markedly effective, 39 were effective, 43 were ineffective, and the total effective rate was 65.04%. The interval of the second follow-up to the first visit averaged 57.48 ± 7.91 months, and the mean TEQ scores were 3.42 ± 3.39 during the interval; 37 cases were cured, 21 were markedly effective, 26 were effective, 39 were ineffective, and the total effective rate was 68.29%. Conclusion Comprehensive traditional Chinese medical therapy for regulating spleen and stomach has certain effect in treating tinnitus, and the long-term effect is satisfactory.

[Clinical and prognostic analysis of decompensated cirrhosis patients Escherichia coli bloodstream infections].

OBJECTIVE: To investigate the clinical characteristic and drug resistance of decompensated cirrhosis patients bloodstream infections causing by Escherichia coli, and determine risk factors for mortality among patients with bloodstream infections. METHODS: The clinical data and drug susceptibility of decompensated cirrhosis patients Escherichia coli bloodstream infections from 2009 to 2012 in 302 hospital of PLA were retrospectively analyzed. Univariable and multivariable Logistic regression was used to identify independent risk factors for all-cause mortality. RESULTS: A total 211 strains of E. coli were isolated from decompensated cirrhosis inpatients, 80 strains ESBLs detecting were positive, positive rate was 37. 9%. Most of infection source were uncertain. The drug resistance of ESBLs positive strains was higher than ESBLs negative strains, but no statistical difference existed in age, sex, basic disease, infection source, peak temperature, white blood cell count, the percentage of neutrophils between ESBLs positive strains and negative strains. 154 patients were survived and 57 patients were died after treatment, with a mortality of 27. 01%. On multivariate analysis, independent risk factors for in-hospital mortality were old age [odds ratio (OR) = 2.429], abnormal pulse (OR = 2.977), liver failure (OR = 11.159), hepatic encephalopathy (OR = 2.524 ) , septic shock (OR = 8.837), acute kidney injury (OR = 3.758), gastrointestinal bleeding(OR = 4.118). Body temperature of > 39 °C (OR = 0.301) had protective effect to lower mortality. A Logistic probobility model was created by adding points for each independent risk factor, and had a c-statistic of 0.898. CONCLUSIONS: Due to decompensated cirrhosis patients Escherichia ecu bloodstream infection severity and had prognosis, early effective antimicrobial therapy and severe complication prevention should be taken to reduce mortality.

Clinical Observation of Comprehensive Chinese Medicine Therapy for Salvage Treatment of Sudden Deafness / 广州中医药大学学报

Objective To evaluate the effect on salvage treatment of sudden deafness with comprehensive Chinese medicine therapy. Methods Fifty-three sudden deafness patients failing in conventional western medicine treatment were given comprehensive Chinese medicine therapy, and the salvage treatment followed by oral use of Chinese medicine, intravenous injection of Chinese patent medicine, acupoint injection, ear acupoint plastering, acupoint application, acupuncture, sound healing, and massage. The therapeutic effect and the relief of major accompanying symptoms were evaluated after treatment, and the relationship of disease course with clinical efficacy was also investigated. Results (1) After treatment, 4 cases were cured, 9 were markedly effective, 13 were effective, 27 were ineffective, and the total effective rate was 49.06%. (2) Except for the 2 excluded cases, the major accompanying symptoms such as tinnitus, auricular distress, and vertigo were relieved to various degrees in other cases. ( 3) Twenty-two patients had a course of disease within 14 days, and the total effective rate for them was 72.73%. A total effective rate of 32.26% was achieved in 31 cases with disease course over 14 days. It is indicated that the therapeutic effect for patients with a disease course less than 14 days was superior to that with a disease course over 14 days (P<0.01). Conclusion Comprehensive Chinese medicine therapy exerts inspiring therapeutic effect on salvage treatment of sudden deafness, and earlier intervention results into better effect.

Effects of Titrofiban with Different Medication Timing on Blood Flow and Complications in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention / 中国药房

OBJECTIVE:To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention(PCI). METHODS:214 cases of acute ST-seg-ment elevation myocardial infarction were divided into late stage group(n=98)and early stage group(n=116)based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI;the former was given intravenous injection of tirofi-ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation,cardiac function and microcirculatory perfusion index before and after operation,and complications during hospitalization were also compared. RESULTS:Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group,and 30-65 min in late stage group,with statistical significance (t=8.94,P=0.00);during angiography,the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases(13.8% and 20 cases(17.2%)in early stage group,which were higher than in late stage group [7 cases (7.1%),9 cases (9.2%)],with statistical significance (P0.05). The amount of 4 and 8 h creatine kinase MB,and postoperative 24 h LVEF of 2 groups were similar after operation,without statistical significance (P>0.05);ST segment of early stage group drop value was (1.93 ± 0.57) mm,which was significantly higher than that of late stage group(1.07±0.29)mm,with statistical significance(P<0.05);the incidence of cardiac adverse events and bleeding compli-cation were 3.45%and 7.76%in early stage group,and 4.08%and 5.10%in late-stage group,without statistical significance(P<0.05). CONCLUSIONS:Different medication timing has no significant effect on the safety of tirofiban,but clinical outcomes and angiographic results are consistent. However,early treatment can improve IRA prorsal blood flow rate before PCI,which is the good medication timing of tirofiban.

Metabolic syndrome and colon cancer:a Meta-analysis / 重庆医学

Objective To investigate the association between Metabolic syndrome and colon cancer.Methods A literature search was performed through PubMed,Ovidsp,CNKI and Wangfang Data within the time limit of January 1 990 to May 2014.Ac-cording to the inclusion and exclusion criteria,the studies were screened and the data were extracted.Then Meta-analysis was per-formed using Stata Statistical Software version 12.0.Results A total of 8 studies(6 cohort studies and 2 case-control studies)met the inclusion criteria.Meta analysis showed that patients with Metabolic syndrome had a higher risk of colon cancer incidence com-pared with the control group without Metabolic syndrome(OR =1.43,95%CI :1.23 - 1.66,P <0.05 ).Stratified analysis showed Metabolic syndrome had a higher risk of colon cancer incidence in male(OR=1.50,95%CI :1.22-1.84,P <0.05),but in female, this association was not found(OR=1.39,95%CI :0.98- 1.96,P =0.07).In addition,Meta analysis showed that Metabolic syn-drome was not associated with an increased risk of colon cancer mortality(OR=1.22,95%CI :0.92-1.63,P =0.1 7).Conclusion This Meta analysis indicated a positive association between Metabolic syndrome and colon cancer incidence in male,but not in fe-male.Metabolic syndrome might not be associated with an increased risk of colon cancer mortality,yet it needs more prospective co-hort studies to confirm the conclusion.

Antimicrobial resistance of 235 strains of Escherichia coli isolated from patients with bloodstream infection / 中国感染控制杂志

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli )isolated from patients with bloodstream infection,and provide evidence for rational use of antimicrobial agents in clinical practice.Methods BacT/A-lert automated blood culture system and VITEK 2 automated identification system were used for bacterial culture and identi-fication.Antimicrobial susceptibility testing and detection of extended-spectrum β-lactamases (ESBLs)-producing strains were performed by Kirby-Bauer method.Results From 2009 to 2011 ,a total of 235 strains of E.coli were isolated from patients with bloodstream infection,90 (38.30%)of which were ESBLs positive strains.The resistant rates of ESBLs-producing strains to ampicillin,cefotaxime and ceftriaxone were all 100%,but susceptibility rate to imi-penem/cilastatin and meropenem were all 100%,to cefmetazole and amikacin were >90%.The resistant rate of non-ESBLs-producing strains to ampicillin was the highest (70.63%),susceptibility rate to imipenem/cilastatin and meropenem were both 100%,to amikacin,cefotaxime,and cefmetazole were all >95%.The resistant rate of ES-BLs-producing strains was significantly higher than that of the non-ESBLs-producing strains.Ofβ-lactamase inhibi-tor,only susceptibility rate of ESBLs-producing E.coli to cefoperazone/sulbactam was>90%,susceptibility rates to piperacillin/tazobactam and ticarcillin/clavulanate were both<80%.Conclusion Antimicrobial resistant rate of ESBLs-producing strains causing bloodstream infection is high,individualized treatment strategies should be made according to antimicrobial resistance of bacteria causing infection in patients.

Correlation of TCM Syndrome Patterns of Chronic Pharyngitis with Related Factors / 广州中医药大学学报

Objective To explore the correlation of TCM syndrome patterns of chronic pharyngitis(CP)with etiological factors.Methods A questionnaire investigation was carried out in 102 CP patients,of which 30 were differentiated as lung-kidney yin deficiency,30 as spleen-stomach deficiency,30 as phlegm coagulation and blood stasis,and 12 as spleen-kidney yang deficiency.The dietary hobbies,living and working environment,systemic diseases and living habits of the patients were recorded.Meanwhile,parameters of the pharyngeal microorganism and immunology were detected.Results The results of nonparametric test showed significant difference between the age and the mean disease course of the four syndrome patterns(P0.05). There existed significant difference between indulging in spicy food,indulging in cold and raw food,and staying up at night in the four syndromes (P0.05).The distribution of the four syndromes was different in the population with medical history of tonsillitis,dental caries,chronic cough,chronic gastritis and chronic colitis(P0.05).Conclusion The syndrome patterns of chronic pharyngitis are correlated with age,disease course,dietary habits of indulging in spicy food and cold-raw food,living habit of staying up at night,systemic disease or disease of organs around the throat,but are not correlated with sex,household registration,job,working and living environment,indulging in frying food,hobbies of smoking and drinking,living habits,emotional factors,throat swab culture results and immune parameters.