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OBJECTIVE To establish comprehensive quality evaluation method based on multi-index components combined with multivariate statistical analysis， and to comprehensively evaluate the quality of Periploca forrestii. METHODS Taking 11 batches of P. forrestii medicinal materials from different areas in Guizhou as samples， the contents of neochlorogenic acid， cryptochlorogenic acid， chlorogenic acid， procyanidin A2， isochlorogenic acid A and isochlorogenic acid C were determined by HPLC. Clustering heat map analysis， grey correlation analysis（GRA） and technique for order preference by similarity to ideal solution（TOPSIS） were used to evaluate the quality of P. forrestii. RESULTS The results of methodological investigation of content determination were in accordance with the relevant regulations， and the linear relationship and accuracy of each component were good in their respective sampling range. The contents of chlorogenic acid， cryptochlorogenic acid， neochlorogenic acid， procyanidin A2， isochlorogenic acid A and isochlorogenic acid C in 11 batches of samples were 3.650-7.302， 0.888-2.575， 1.371- 2.386， 0.947-1.469， 0.084-0.169 and 0.725-1.067 mg/g， respectively. The content of each component was significantly different， with the highest content of chlorogenic acid and the lowest content of isochlorogenic acid A. The comprehensive results of cluster heat map， GRA and TOPSIS analysis showed that the comprehensive quality of S5 and S10 was relatively good. CONCLUSIONS The established method is accurate， stable and simple. Combined with multivariate statistical analysis method， it can be used for quality evaluation of P. forrestii. The quality of samples from Jiuzhou Town and Caiguan Town of Xixiu District in Anshun City of Guizhou Province are relatively good among 11 different origin samples.
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External beam radiation therapy (EBRT) is one of the main treatments for prostate cancer, and image-guided implementation of EBRT is more suitable for accurate radiotherapy. As a new type of image-guided technology, the Clarity system has been applied in the real-time tracking during EBRT for prostate cancer in clinical practice. While improving the accuracy of EBRT targeting, it also significantly reduces the side effects of traditional EBRT. In this article, the application of Clarity system in EBRT of prostate cancer and its existing problems were systematically elucidated.
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Objective:To compare the impact of remimazolam and propofol on the quality of postoperative recovery in aged patients with goal-directed hemodynamic management strategies.Methods:Ninety patients of either sex, aged 65-80 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic gastrointestinal tumor surgery, were divided into 2 groups ( n=45 each) using a random number table method: remimazolam group (group R) and propofol group (group P). Anesthesia was induced as follows: remimazolam 6 mg·kg -1·h -1 was intravenously infused in group R, and propofol 2 mg/kg was intravenously injected in group P. Anesthesia was maintained as follows: remimazolam 0.5-1.0 mg·kg -1·h -1 was intravenously infused in group R, propofol 4-12 mg·kg -1·h -1 was intravenously infused in group P, and BIS values were maintained at 40-60 during operation.Both groups adopted a goal-directed hemodynamic management strategy during operation, and the volume infused and vasoactive drugs were adjusted according to stroke volume variation of 4%-12% and cardiac index of 2.5-4.0 L ·min -1·m -2.The 40-item Quality-of-Recovery scale (QoR-40) was used to assess the quality of postoperative recovery.QoR-40 score was performed 1 day before surgery, 3 days after surgery and 30 days after surgery.The intraoperative consumption of vasoactive drugs and occurrence of intraoperative hypotension and bradycardia were recorded, and the concentration of lactic acid was measured before operation, after operation and 24 h after operation in the two groups.The recovery time of consciousness, tracheal extubation time, duration of postanesthesia care unit stay and postoperative length of hospital stay were recorded.The occurrence of postoperative complications was also recorded. Results:Compared with P group, the incidence of intraoperative hypotension and bradycardia was significantly decreased, the consumption of dopamine and norepinephrine was reduced, the concentration of lactic acid was decreased, QoR-40 scores were increased at 3 and 30 days after operation, the postoperative length of hospital stay was shortened, and the incidence of postoperative complications was decreased in group R ( P<0.05). Conclusion:Remimazolam provides better efficacy than propofol in improving the quality of postoperative recovery in elderly patients with goal-directed hemodynamic management strategy.
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Objective:To evaluate the efficacy of remazolam combined with remifentanil anesthesia for radical surgery for gastric cancer in frail aged patients.Methods:One hundred and twenty patients of either sex, aged 65-75 yr, with body mass index 18-28 kg/m 2, with simple frailty questionnaire score 3-5 points, undergoing elective laparoscopic radical gastric cancer surgery, were divided into 3 groups ( n=40 each) according to the random number table method: propofol combined with remifentanil group (P group), low-dose remazolam combined with remifentanil group (B1 group) and high-dose remazolam combined with remifentanil group (B2 group). Induction of anesthesia was as follows: propofol 2 mg/kg was intravenously injected in group P, remazolam 6 and 12 mg·kg -1·h -1 were intravenously infused in group B1 and group B2, respectively, and alfentanil and rocuronium were intravenously injected after loss of consciousness in three groups.Anesthesia maintenance was as follows: propofol 4-12 mg·kg -1·h -1 was intravenously infused in group P, remazolam 0.5-1.0 mg·kg -1·h -1 was intravenously infused in B1 and B2 groups, remifentanil 0.05-0.20 μg·kg -1·h -1 was intravenously infused in three groups, and intravenous rocuronium was injected intermittently to maintain the BIS value at 45-55 intraoperatively.The time to loss of consciousness, recovery time of consciousness and time of tracheal extubation were recorded.The occurrence of injection pain during induction of anesthesia, intraoperative cardiovascular events, intraoperative awareness, and respiratory depression, nausea and vomiting, and drowsiness during postanesthesia care unit were recorded. Results:Compared with group P, the time to loss of consciousness was significantly prolonged, the incidence of injection pain, intraoperative hypotension and bradycardia was decreased, and the incidence of postoperative somnolence was increased in B1 and B2 groups ( P<0.05). The time to loss of consciousness was significantly shorter in group B2 than in group B1 ( P<0.05). There was no statistically significant difference in the recovery time of consciousness, time of tracheal extubation, postoperative respiratory depression and incidence of nausea and vomiting among the three groups ( P>0.05). Conclusion:Remazolam combined with remifentanil anesthesia can be safely and effectively used for radical surgery for gastric cancer in frail aged patients.
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Objective:To study the relationship between KRAS gene mutation and clinical parameters and prognosis in patients with colorectal cancer liver metastases (CRLM).Methods:To retrospectively study the impact of different KRAS status on the clinical parameters parameters and prognosis of 1 248 patients with CRLM treated from January 2005 to December 2019 at the First Medical Center, Chinese PLA General Hospital. There were 880 male and 368 female, age ranged from 21 to 88, median 56. The single factor and multi-factor logistic regression analyses were used to identify factors relating to KRAS mutation. Survival was analyzed by the Kaplan-Meier method, and survival rate by the log-rank test.Results:There were 729 KRAS gene wild-type patients and 519 mutant patients. The mutation rate was 41.6%(519/1 248). Primary site of tumor in 11 patients were located in the bilateral colon. The KRAS gene mutation rates between the male and female CRLM patients whose CA19-9 level were ≥38 g/L and <38 g/L, with or without diabetes, and whose primary sites were on the right (52.1%, 160/307) or the left colon (38.2%, 355/930) was significantly different (all P<0.05). A single factor logistic regression analysis showed that gender, CA19-9 levels, diabetes and the primary site were associated with KRAS mutations, with significant difference ( P<0.05). Multivariate logistic regression analysis showed that the primary site of tumor was an independent influencing factor of KRAS mutation ( OR=0.557, 95% CI: 0.423-0.733, P<0.05). The overall survival rates of KRAS wild-type patients was significantly higher than mutant patients ( P<0.05). Conclusion:Among patients with CRLM, KRAS mutation was more frequently appeared in those patients with right sided colonic cancer. The long-term prognosis of patients with KRAS mutant was significantly worse.
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Objective: To observe the effect of oxidative-low density lipoprotein (ox-LDL) injured human leukemia mononuclear cells (THP-1) adhesion to human umbilical vein endothelial cells (HUVECs)in vitrowith the intervening function of dredging collateral drug, tongxinluo (TXL) and ginsenoside (Rb1). Methods: Cell injury was induced by ox-LDL treatment. The cells were divided into 4 groups:①Normal control group,②Injury model group, the cells were cultured by ox-LDL,③TXL group, the cells were cultured with both ox-LDL and TXL,④Rb1 group. HUVEC viability was measured by MTS assay, adherence rate of THP-1 cells to HUVECs was tested by vital cell staining. The contents of monocyte chemoat-tractant protein (MCP-1), soluble vascular cell adhesion molecule (sVCAM-1), soluble inter vascular cell adhesion molecule-1 (sICAM-1) and E-selectin in HUVEC conditioned medium were detected by ELISA; protein expressions of CCR2, VLA4 and Mac-1 in THP-1 cells were examined by Western blot analysis. Results: Compared with Control group, HUVEC viability was decreased in Injury model group (100 ±1.31) % vs(75.57 ± 1.02) %, while increased in both TXL and Rb1 groups (99.25 ± 1.40) % and (99.48 ± 2.15) %; Injury model group showed elevated adherence rate of THP-1 cells to HUVECs, while the adherence rates were reduced in both TXL and Rb1 groups. Compared with Injury model group, TXL group and Rb1 group showed decreased levels of MCP-1, sVCAM-1, sICAM-1 and E-selectin in HUVEC conditioned medium; decreased protein expressions of CCR2, VLA4 and Mac-1 in THP-1 cells. Conclusion: TXL and Rb1 could protect HUVECs, reduce ox-LDL injury induced vascular endothelial cell adhesion and decrease relevant receptor expression in monocytes; therefore, inhibit injured monocytes adherence to vascular endothelial cells.
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Ob jectiev Oxidized low-density lipoprotein ( ox-LDL) induces vascular endothelial cell injury , which is one of the factors initiating atherosclerosis .This study aimed to investigate the protective effect of Tongxinluo ( TXL ) on vascular endothelial cells with ox-LDL-induced injury . Methods Human umbilical vein endothelial cells ( HUVEC ) were cultured in vitro and divided into five groups:normal control, oxidative stress injury (OSI) model, and high, medium and low dose TXL.The HUVECs were incubated with ox-LDL at the concentration of 30 mg/L for 24 hours to induce oxidative stress injury and then treated with TXL at 50, 100 and 150 mg/L for 4 hours, followed by 24 hour incubation with 30 mg/L ox-LDL added to the culture medium .The viability of the cells was detected by MTS assay, the nitric oxide (NO) content, superoxide dismutase (SOD) activity and mitochondrial membrane poten-tial ( MMP) in the cell culture supernatant were measured with respective kits , and the expressions of iNOS , MMP9, and NF-κBp65 proteins were determined by Western blot . Results The HUVECs of the OSI model group showed a significant decrease in cell via-bility compared with the normal control , ([73 .89 ±0.67] vs [100.00 ±2.23]%, P<0.01) but a remarkably increase after treated with medium and high dose TXL ([92.15 ±0.76]%and [ 97.19 ±1.45]%, P<0.01).The MMP, NO content, and SOD activity were markedly reduced in the model group (P<0.01) but elevated in the low, medium, and high dose TXL groups (P<0 .01).The expressions of the iNOS, MMP9, and NF-κBp65proteins were significantly up -regulated in the model group (P<0.01) but down reg-ulated in the low, medium, and high dose TXL groups (P<0.05).C on clusion TXL has the effects of anti-oxidation and anti-in-flammation and can protect vascular endothelial cells against ox-LDL-induced injury .
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Objective To evaluate the changes in mRNA expressions of Toll-like receptor 4 (TLR4) and its down-stream cytokines IL-1β,IL-6 and TNF-a in incisional tissues from a rat with postoperative pain.Methods Incisional pain was induced in 74 male adult SD rats weighing 200-250 g.Paw mechanical withdrawal threshold (PMWT) around the wound on the operated and nonoperated sides was measured at 1 day before operation and at 0.5,1,2,6 and 12 hours as well as 1,2,3,5 and 7 days after operation.Skin incisional tissues were removed for determination of mRNA expressions of TLR4,IL-1β,IL-6 and TNF-a using real-time quantitative PCR at 1 day before operation and at 2 and 8 hours as well as 1,2,3,5 and 7 days after operation.Results Compared with the baseline value before operation,PMWT on the operated side was significantly decreased at 0.5 hours-5 days after operation,mRNA expression of TLR4 around the wounds on the operated side was down-regulated at 2 hours after operation followed by a gradual increase,mRNA expressions of IL-1β,IL-6 and TNF-α on the operative side were up-regulated at 2 and 8 hours as well as 1,2,3 and 5 days after operation (P ＜ 0.05),but no significant changes were found in PMWT and mRNA expressions of TLR4,IL-1β,IL-6 and TNF-α on the non-operated side(P ＞ 0.05).PMWT on the operated side was lowest at 6 hours after operation followed by the gradual increase,mRNA expression of TLR4 on the operated side peaked at 2 days after operation,and mRNA expressions of IL-1β,IL-6 and TNF-a respectively peaked at 2 hours,1 day and 3 days after operation (P ＜ 0.05).mRNA expressions of TLR4,IL-1β,IL-6 and TNF-a were negatively correlated with PMWT on the operative side (r =-0.501,-0.743,-0.893,-0.657,P ＜ 0.05),and mRNA expressions of IL-1 β,IL-6 and TNF-a were positively correlated with the level of TLR4 mRNA(r=0.764,0.283,0.667,P＜0.05).Conclusion mRNA expressions of TLR4 and its down-stream cytokines IL-1 β,IL-6 and TNF-a in skin incisional tissues are up-regulated,which may be involved in the development and maintenance of postoperative pain.
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Objective:To explore the effectiveness and safety of simvastatin combined ezetimibe in patients with acute coronary syndrome (ACS).Methods:A total of 124 ACS patients complicated low density lipoprotein cholesterol (LDL-C)>100 mg/dl were selected from our hospital from May 2012 to May 2013. They were randomly and equal-ly divided into rosuvastatin group (received rosuvastatin 20mg/d)and combined treatment group (received simvasta-tin 40mg/d plus ezetimibe 10mg/d),both groups were treated for one month.Blood lipid levels and incidence rates of adverse reactions were observed in two groups.Results:Compared with before treatment,after one-month treat-ment there were significant reductions in levels of LDL-C,total cholesterol (TC)and triglyceride (TG)and signifi-cant rise in levels of high density lipoprotein cholesterol (HDL-C)in both groups (P 0.05).Incidence rate of myalgia in combined treatment group was significantly lower than that of rosuvastatin group (4.8% vs.17.7%,P =0.023), but there were no significant difference in incidence rates of other adverse reactions between two groups (P >0.05 all).Conclusion:It′s effective and safe to use simvastatin combined ezetimibe in patients with acute coronary syn-drome,which is worthy extending.
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AIM: To explore the role of PI3K/Akt/nNOS in Zhouluotong extract resisting diabetic peripheral neuropathy.METHODS:The Schwann cells were divided into normal group ( D-glucose 25 mmol/L) , model group ( D-glucose 100 mmol/L) , Zhouluotong extract Z-6 +high glucose group, Zhouluotong +high glucose group, mecobalamine+high glucose group.The viability, nitric oxide content and the Ca2+-ATPase activity in Schwann cells were determined by Cell Counting Kit-8 , nitric oxide assay kit and Ca2+-ATPase assay kit, respectively.The apoptosis of Schwann cells were analyzed by flow cytometry.The expression of Bcl-2, Bcl-xL, Bax, Bak and caspase-3, and the phosphorylation levels of nNOS and Akt were determined by Western blotting.The signal pathway of PI3K/Akt was explored by dominant negative PI3K and Akt (δp85 and DN-Akt) transient transfection assay.RESULTS:Under high-glucose culture, the cell viability, nitric oxide content in culture supernatant, the expression of Bcl-2 and Bcl-xL, and the phosphorylation levels of Akt and nNOS in the Schwann cells were significantly increased.The cell apoptosis, the expression of Bax, Bak and caspase 3 in the Schwann cells were significantly decreased by Zhouluotong extract Z-6, compared with model group.In-creased nitric oxide content and the up-regulation of nNOS were observed.However, the effects of blocking PI3K/Akt, the upstream pathway of nNOS , by transfection with DN-δp85 on Akt phosphorylation in the Schwann cells was still unclear. CONCLUSION:Zhouluotong extract Z-6 changes the phosphorylation of nNOS, and the expression of anti-apoptotic fac-tors , caspase-3 and pro-apoptotic factors in Schwann cells under high-glucose culture, thus reducing apoptosis and elevating viability.The relationship to PI3K/Akt/nNOS pathway needs further investigation.
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Objective To evaluate the changes in the expression of Toll-like receptor 4 (TLR4) mRNA and its down-stream cytokines IL-1β and TNF-α mRNA in spinal cord in a rat model of incisional pain.Methods Fifty-eight male Sprague-Dawley rats,weighing 180-220 g,were used in this study.A 1-cm longitudinal incision was made through skin,fascia and muscle of the plantar aspect of the hindpaw in isoflurane-anesthetized rats.Mechanical paw withdrawal threshold to yon Frey filament stimulation (MWT) on the operated and non-operated sides was measured before operation and at 0.5,1,2,6 and 12 h and 1,2,3,5 and 7 days after operation.Six rats were chosen and sacrificed before operation and at 2 and 8 h and 1,2,3,5 and 7 days after operation.Their lumbar segments (L4-6) of the spinal cord were removed for determination of the expression of TLR4,IL-1β and TNF-α mRNA by real-time PCR.Results Compared with the baseline value before operation,MWT on the operated side was significantly decreased at 0.5 h-5 days after operation,and the expression of TLR4,IL-1β and TNFα mRNA was up-regulated at 2 and 8 h and 1,2 and 3 days after operation (P ＜ 0.05),and no significant change was found in MWT on the non-operated side (P ＞ 0.05).MWT on the operated side was lowest at 2 h after operation and then gradually increased,the expression of TLR4 mRNA peaked on 1 day after operation,and the expression of IL-1 and TNF-α mRNA peaked at 8 h after operation (P ＜ 0.05).The TLR4 mRNA expression was negatively correlated with MWT on the operative side (r =-0.484,P ＜ 0.05),and IL-1 mRNA and TNF-α mRNA expression was positively correlated with TLR4 mRNA (r =0.294 and 0.540,respectively,P ＜ 0.05).Conclusion The expression of TLR4 mRNA and its down-stream cytokines IL-1β and TNF-α(mRNA in spinal cord is up-regulated,this change is involved in the maintenace of incisional pain,but it does not play an important role.
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Objective To compare the clinical pharmacodynamics of domestic and imported propofol by target-controlled infusion. Methods This was a prospective,randomized,double-blind,cross-over study. Eighteen ASA Ⅰ or Ⅱ patients aged 45-55 yr undergoing substitute valve operation for severe deep venous were randomly divided into sequential Ⅰ and Ⅱ , in sequence Ⅰ , the imported propofol was applied in the first stage of surgery and then domestic propofol in the second stage surgery, while in sequence Ⅱ the order was reversed. The target plasma concentration of propofol was initially set at 0.5 μg/ml, followed by increments of 0.5 μg/ml when the effect-site concentration and plasma concentrations was balanced, until the predicted effect-site concentrations reached 3.5 μg/ml. BIS value, RR, SpO2 and hemodynamics were recorded at 0,0.5, 1.0,1.5,2.0,2.5,3.0 and 3.5 μg/ml effect-site concentration level, the predicted effect-site concentrations and the BIS value at loss of consciousness in 5%, 50% and 95% of the patients were calculated. Adverse reactions were recorded during the trial period.Results Under the same effect-site concentration,there was no significant difference in BIS value,RR, SpO2 and hemodynamic monitoring indicators between the two drugs( P ＞ 0.05). There was no significant difference in predicted effect-site concentrations of propofol, the BIS value at loss of consciousness in 5%, 50% and 95% of the patients and the incidence of adverse reaction between the two drugs ( P ＞ 0.05). Conclusion The domestic propofol and imported propofol have clinical bioequivalence.