ABSTRACT
The review summarizes the kidney protective mechanism of sodium-glucose-coupled transporter 2 inhibitors and their efficacy and safety for diabetic recipients of kidney transplantation.It is intended to improve patient outcomes.
ABSTRACT
Brachythrapy is a technique to implant radioactive isotype into or near tumors.The obvious properties of brachytherapy are a very high dose distribution of center,and rapid dose attenuation with the increasing of distance.Brachytherapy generally includes three major categories:low dose rate,high dose rate and pulse dose rate.The most significant clinical value of brachytherapy is that it could create dose distribution to tumor tissues,but decreased radiation injury of normal tissues close to tumor.The development of the clinical brachytherapy technique is always involved in the radiobiological characteristics.The basic concepts involving clinical brachytherapy radiobiology mainly includes:dose-rate effect,repair of radiation injury,re-oxygenation,cell cycle redistribution and repopulation.An amount of translational medical approach is needed to guide the application of clinical brachytherapy by exploring the interaction between brachytherapy radiobiology and clinical brachytherapy effect,as well as taking advantage of brachytherapy radiobiological characteristics.The ultimate goal is to improve tumor local control rate,reduce the occurrence of adverse reactions,and improve patients' overall survival.
ABSTRACT
Objective To discuss the dosimetric advantage of computed tomography-guided interstitial brachytherapy compared with the conventional intracavitary brachytherapy for locally advanced cervical cancer,offering a more advantageous clinical treatment approach. Methods Twenty-eight locally advanced cervical cancer patients with bulky tumors ( tumor size>5 cm) after external beam radiotherapy received computed tomography-guided interstitial brachytherapy. Dosimetric outcomes of the current study, including the total dose ( external beam radiotherapy+ brachytherapy ) D90 for the HR-CTV and D2cc for the bladder,rectum, and sigmoid, were compared with a former patient group consisting of 30 patients who received the conventional intracavitary brachytherapy ( uterine tandem+ ovoid pairs ) . Results The mean D90 value for HR-CTV in the intracavitary brachytherapy group and interstitial brachytherapy group were (76.9±5. 7) and ( 88.1± 3. 3) Gy, respectively. The D2cc for the bladder, rectum, and sigmoid in the intracavitary brachytherapy group and interstitial brachytherapy group were (84.7±6. 8) Gy,(69.2±4. 2) Gy,(67.8±4. 5) Gy and (81.8±6. 5) Gy,(6.8±4. 0) Gy,(64.8±4. 1) Gy,respectively.1-year local tumor control rate in the intracavitary brachytherapy group and interstitial brachytherapy group were 59. 3％ and 85. 2％, respectively. Conclusions CT-guided interstitial brachytherapy shows a significant dosimetric advantage compared with the conventional intracavitary brachytherapy, and is, thereby, clinically possible feasible. However,the long term curative effect and toxicity need to be further investigated.
ABSTRACT
Objective To analyze the dosimetric advantages of CT-guided interstitial brachytherapy for recurrent cervical cancer. Methods A total of 16 patients with recurrent cervical cancer after radical surgery and adjuvant external beam radiotherapy received interstitial brachytherapy with CT-guided implantation of metal needles. The high-risk clinical target volume (HR-CTV) was given 36 Gy in 6 fractions.D90for HR-CTV in the brachytherapy and the cumulative D2 cm3values for the bladder,rectum,and sigmoid colon in the previous external beam radiotherapy and the brachytherapy were analyzed.Results The mean D90value for HR-CTV was 52.5±3.3 Gy. The cumulative D2 cm3values for the bladder, rectum, and sigmoid colon were 85.6±5.8 Gy,71.6±6.4 Gy,and 69.6±5.9 Gy,respectively.The mean number of metal needles was 6.1±1.5 in each brachytherapy. The actual 1-year overall survival and local control were 81% and 69%, respectively. Conclusions CT-guided interstitial brachytherapy for recurrent cervical cancer shows good dose-volume histogram parameters and few complications, so it may be clinically feasible. However,its long-term clinical efficacy needs further observation.
ABSTRACT
Objective To examine the dosimetric advantages of three-dimensional (3D) computed tomography (CT)-guided interstitial brachytherapy (BT) for target volume and surrounding normal tissue in patients with locally advanced cervical cancer,and to provide a simple and effective clinical treatment approach.Methods A total of 52 patients who had poor tumor response to external beam radiotherapy (EBRT) with a residual tumor greater than 5 cm at the time of BT were included.The patients were treated by 3D CT-guided interstitial BT using a hybrid applicator comprised of uterine tandem and free metal needles.The high-risk clinical target volume (HR-CTV),intermediate-risk clinical target volume (IR-CTV),and organs at risk (OAR) were contoured.The total dose,including external beam radiotherapy and high dose-rate BT,was biologically normalized to conventional 2 Gy fractions (EQD2).D90and D100for both HR-CTV and IR-CTV,and D2 ccfor the bladder,rectum,and sigmoid were analyzed.Results The mean D90value for HR-CTV was 88.4±3.5 Gy.The D2 ccfor the bladder,rectum,and sigmoid were 81.1±5.6,65.7±5.1,and 63.1±5.4 Gy,respectively.D2 cc≤90 Gy for the bladder and D2 cc≤70 Gy for the sigmoid were observed in all the patients.D2 cc≤70 Gy for the rectum was observed in 89% of patients.Conclusions 3DCT-guided interstitial BT has a significant dosimetric advantage for target volume accompanied by few minor complications,and thereby may be clinically feasible for treating locally advanced cervical cancer.However,its long-term efficacy and possible toxicities will require further clinical observation.
ABSTRACT
Objective To investigate the dosimetric difference between inverse planning simulated annealing(IPSA)and manual optimized plan for isodose line in interstitial brachytherapy for locally advanced cervical cancer and to provide a better optimization method for clinical application. Methods A total of 104 patients with cervical cancer were enrolled in this study. They received pelvic external beam radiotherapy and interstitial brachytherapy in five fractions. Both IPSA and manual optimized plan for isodose line were used to optimize the dose in each fraction. Dose volume parameters of the two plans were compared to analyze the dosimetric outcome by paired t-test. Results There were no significant differences in mean D 90and D 100for high-risk clinical target volume(HR-CTV)and D 90for intermediate-risk clinical target volume(IR-CTV)between the two groups(P>0.05). The IPSA group had a significantly higher D 100for IR-CTV than the manual optimized group(58.36±2.06 Gy vs. 53.99±2.17 Gy, P=0.025). For organs at risk,the IPSA group had a significantly lower mean rectum D 2ccand a significantly higher bladder D 2ccthan the manual optimized group(68.53± 2.85 Gy vs. 71.77± 1.79 Gy, P=0.002;80.49± 3.36 Gy vs. 78.71± 2.64 Gy,P=0.034). There was no significant difference in sigmoid D 2ccbetween the two groups(P>0.05). The IPSA group had significantly higher relative dose homogeneity index(HI)and conformity index (CI)of radiation dose for target volume than the manual optimized group(P<0.05), and there was no significant difference in overdose volume index(OI)between the two groups(P= 0. 1 0 7).Conclusions Compared with manual optimized plan for isodose line, IPSA can improve the dose distribution of tumor tissue,reduce mean rectum D 2cc,and increase CI and HI,so it is a preferable optimized treatment planning method in clinical application.
ABSTRACT
Objective To evaluate the efficacy of hydromorphone for postoperative parent-controlled intravenous analgesia in pediatric patients.Methods Seventy-five pediatric patients of both sexes,aged 2-5 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective surgery for treatment of developmental displasia of the hip,were divided into 2 groups using a random number table:sufentanil group (group S,n =38) and hydromorphone group (group H,n =37).Parent-controlled intravenous analgesia was carried out within 48 h after operation.Parent-controlled intravenous analgesia solution contained sufentanil 2 μg/kg (group S) or hydromorphone 200 μg/kg (group H) in 100 ml of normal saline.The analgesia pump was set up with a 0.5 ml bolus dose,a 15-min lockout interval and infusion at a rate of 0.5 ml/h.Ramsay sedation scores were recorded at 0.5,1,4,8,12,24 and 48 h after extubation (T1-7).At 1 h before operation (To),T3 and T6,blood samples were collected from the ulnar vein for determination of the concentration of substance P in serum.The total consumption of analgesics,the number of successfully delivered doses,the number of attempts and drug-related adverse reactions were recorded,and parents' satisfaction was scored.Results Compared with group S,Ramsay sedation scores were significantly decreased at T1-3,the number of attempts was increased (P＜0.05),and no significant change was found in the total consumption of analgesics,the number of successfully delivered doses,degree of parents' satisfaction,serum concentration of substance P or incidence of drug-related adverse reactions in group H (P＞0.05).Conclusion Hydromorphone can be safely and effectively used for postoperative parent-controlled intravenous analgesia in pediatric patients.
ABSTRACT
Objective To compare the impact of propofol and sevoflurane on thermoregulation in children undergoing orheopaedic surgery.Methods Sixty-eight children scheduled to undergo ortho-paedic surgery were randomly allocated to receive propofol (group P)and sevoflurane(group S)anes-thesia,34 cases in each group.Tympanic temperature was recorded 5 minutes before (T0 )and 5 min (T1 ),1 5 min (T2 ),30 min (T3 ),45 min (T4 ),60 min (T5 ),75 min (T6 ),90 min (T7 ),105 min (T8 )and 120 min (T9 )after anesthesia.Total fluid intake,duration of surgery,duration of anesthe-sia,the incidence of hypothermia,and the incidence of shivering were also recorded.Results Com-pared with T0 ,in both groups body temperature declined at T1-T8 .There was no difference between the two groups in total fluid intake,duration of surgery,duration of anesthesia and the incidence of shivering.Compared with group P,children in group S had a higher incidence of hypothermia(8 vs 1). Children in group S had lower temperature,which had statistical significance at T7 and T8 (P <0.05). Conclusion The core temperature of children undergoing orthopaedic surgery showed a trend of in-crease after the first fall in the surgery.Compared with propofol,sevoflurane anesthesia is more likely to lead to the incidence of hypothermia in children undergoing orthopaedic surgery in 90 min after in-duction of anesthesia.
ABSTRACT
Objective To summarize the characteristics of multi-slice computed tomography (MSCT) of portal vein diseases and investigate the CT diagnosis of its primary and secondary diseases.Methods The imaging data of 62 patients from Xi'an Xidian Group Hospital,28 patients from Nuclear Industry 215 Hospital of Shanxi Province and 16 patients from Xi'an Gaoxin Hospital with portal vein diseases from January 2012 to March 2015 were retrospectively analyzed.The CT findings,primary and secondary diseases of portal vein lesions were recorded through plain scan and enhanced scan of MSCT.Results Changes in the width of portal vein:among 106 patients,dilation of main portal vein was detected in 45 cases,stenosis of stem or branches of portal vein in 39 cases,portal vein obstruction in 49 cases (21 patients accompanied with enlargement in stem of portal vein and 6 patients with normal width).The diameters of dilated portal vein were 1.4-2.2 cm with a mean diameter of 1.8 cm.The diameters of portal vein with stenosis and occlusion caused by carcinomas were 1.8-4.0 cm with a mean diameter of 2.3cm.Portal vein fistula and pneumatosis:hepatic artery-portal vein fistulas were detected in 12 patients,posterior right branches of portal vein-inferior vena cava fistulas in 2 patients,inferior vena cavaportal vein fistulas and portal-hepatic vein fistulas in 2 patients,pneumatosis in 2 patients.Lesions of portal vein occlusions:occlusions located at main portal veins were detected in 4 cases,left and right branches in 34 cases,both main portal veins and left or right branches in 11 cases.Malignant stenosis and occlusion were detected in 29 and 42 cases,benign stenosis and occlusion were detected in 10 and 7 cases,respectively.Protopathies of portal vein dilation:there were 43 patients with liver cirrhosis and 2 patients with inferior vena cava-portal vein-hepatic vein fistula of Budd-Chiari syndrome.Protopathies of benign stenosis and occlusion:portal vein thrombosis in liver cirrhosis,giant cavernous haemangioma,polycystic disease of liver,pylephlebitis caused by liver abscess,portal vein thrombosis caused by polycythemia vera.Protopathies of hepatic artery portal vein fistula and portal veininferior vena cava fistula:liver cancer and liver cirrhosis,protopathy of inferior vena cava-portal vein fistula and portal vein-hepatic vein fistula were Budd-Chiari syndrome.Protopathies of pneumatosis:intestinal infarction after superior mesenteric artery embolus and acute gastric dilatation.Portacaval collateral circulation occurred in 58 patients (partial patients complicated with multi-point varices and shunts),ascites in 44 patients,portal vein cavernous transformation in 12 patients,ischemia and edema of intestinal wall in 5 patients,intrahepatic cholangiectasis in 19 patients including 17 cases of biliary obstruction caused by malignant tumors and 2 cases of portal vein cavernous transformation complicated with intrahepatic cholangiectasis (portal hypertensive biliopathy).Conclusions The MSCT for portal vein diseases is presented as portal vein stenosis,occlusion or dilation,pneumatosis.Secondary lesions are portacaval collateral circulation,portal vein cavernous transformation,intestinal ischemia and portal hypertensive biliopathy,and primary lesions are mainly liver cirrhosis and malignant tumors.MSCT can show clearly the portal vein lesions and diagnose accurately its primary and secondary lesions.
ABSTRACT
Acute mesenteric ischemia (AMI) is a lifethreatening disease,with high mortality rate and is easily misdiagnosed.Rapid and acute detection of the AMI and its primary diseases by multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) is of great significance.The clinical data of 31 patients with AMI who were admitted to the Xidian Group Hospital from January 2005 to June 2013 were retrospectively analyzed.Stenosis or occlusion of the mesenteric blood vessels,diminished or absent enhancement of the bowel wall are the direct signs of CT,thickening of the bowel wall is the most typical indirect sign of CT.Dilatation or collapse of the bowel lumen and swelling of the mesenterium are the common CT signs.Pneumatosis intestinalis and gas in the portomesenteric vein are reliable CT signs of the Intestinal Infarction.Artery and venous embolism,atherosclerosis,vasculitis,aortitis,strangulated intestinal obstruction and superior mesenteric artery dissection are the possible causes of AMI.
ABSTRACT
Objective To investigate the association between 5-hydroxytryptamine 2A receptor (HTR2A)gene T102C locus polymorphism and schizophrenia,and to provide basis for evidence-based medicine for the genetic background of schizophrenia.Methods PubMed,EMbase,CNKI,WanFang and Vip information databases were used to search full text of all the relevant studies about the association between HTR2A gene T102C locus polymorphism and schizophrenia,which were published during 2003 to 2012.Based on reviewing full text,the data were selected, evaluated and accessed. RevMan 5.1 and Stata 1 2.0 were used to perform the statistical analysis of those studies that were in accordance with the inclusive criteria. According to the different ethnicities, the obj ects were divided into two subgroups as European and Asian to analyze respectively. Also, depending on different inheritances, the obj ects were divided into five patterns including C/T allele, CC/TT, CC/CT+TT, CC+CT/TT and CC+ TT/CT genotypes to analyze respectively, including heterogeneity inspection, effect consoliating and publication bias assessment. Results A total of 11 studies were available for this analysis, including 2 443 schizophrenia patients and 2 469 controls.The Meta-analysis results showed that the allele of all people were OR=1.12,95%CI=0.96-1.31,P>0.05;CC/TT of all people were OR=1.11,95%CI=0.80-1.53,P>0.05;CC/CT+TT of all people were OR=1.13,95%CI=0.99-1.30,P>0.05;CC+CT/TT of all people were OR=1.18, 95%CI=0.93-1.50,P>0.05;CC+TT/CT of all people were OR=0.95, 95%CI=0.84-1.06,P>0.05.Conclusion Current evidence is insufficient to show that HTR2A gene T102C locus polymorphism may be associated with schizophrenia, suggesting that the gene polymorphism has no significantly genetic association with schizophrenia.
ABSTRACT
Hyperuricemia and metabolic syndrome were studied in 17 762 subjects of Tianjin Municipality from July 2007 to July 2009. The overall prevalence rate of hyperuricemia was 12. 16% (2160cases) , the rate in males was significantly higher than that in females (15. 71% vs. 6. 51% , P <0. 01).The overall prevalence rate of metabolic syndrome was 25. 56% (4540 cases) , the rate in males was also higher than that in females (28. 17% vs. 21. 40% , P <0. 01). Binary logistic regression analysis disclosed that females with high uric acid were twice likely to suffer from metabolic syndrome than males; and female ≤ 44 years with hyperuricemia had the highest odd ratio for metabolic syndrome.
ABSTRACT
Objective To study the incidence and clinical significance of the herniation pits of the femoral neck.Methods 600 cases(299 men,301 women,18～82 years)were collected.The incidence,radiologic finding and clinical significance of the herniation pit of the femoral neck were analysed.Results Of 1200 hip joints in 600 cases,there was 58 cases(64 sides)(5.3%)with herniation pits of the femoral neck,including 39 men(68.7%)and 19 women(31.3%),the lesions localized in the left joint in 25 eases(39.1%),in the right joint in 27 cases(42.2%)and in bilateral joints in 6 cases(18.7%).There were a obvious significant differences on both sexes,and no significant differences on age groups.On X-ray film,the lesions appeared as a round radiolucency with thin clear sclerotic rim.Conclusion The incidence of the herniation pit of the femoral neck is 5.3%,which has a typical X-ray feature,and may indicate the femoroacetabular impingement.
ABSTRACT
Two hundred and four patients with diabetic nephropathy and depressive disorder were randomly assigned to the control group (40 cases), St.John's Wort extract (SWE) group(40 cases) ,SWE +psychotherapy group ( 40 cases), SWE + physicotherapy group ( 40 cases ) and SWE + psychotherapy +physicotherapy group (44 cases), all patients were treated for 12 weeks.The therapeutic effects were evaluated with Hamilton Rating Scale for Depression-17 (HAMD-17).The percentage reduction in HAMD scores in SWE + psychotherapy + physicotherapy group was the highest ( 86% ), and those for SWE, SWE +psychotherapy, SWE + physicotherapy and control groups were 47%, 55%, 60% and 13%, respectively (x2 =47.331, P =0.000).After 12 weeks of treatment, glycosylated hemoglobin(HbA1c) and urinary albumin excretion rate (UAER) were reduced in all 4 treatment groups compared with the control group.The levels of HbA1 c and UAER in SWE + psychotherapy + physicotherapy group were significantly lower than those in others ( F = 15.754,74.025, all P = 0.000).St.John' s Wort extract with psychotherapy and physicotherapy can efficiently improve the depressive disorder in type 2 diabetic patients with nephropathy, as well as control blood glucose and reduce UAER of patients.
ABSTRACT
Objective To observe the level of serum hepatocyte growth factor(HGF)in patients with hypertension(HT).Methods HGF,fasting plasma glucose(FBG),postprandial plasma glucose(2hPG),glycosylated hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI)and waistline(w)were detected in 30 patients with hypertension,30 patients with hypertension complicated by type 2 diabetes mellitus(T2DM),and 30 normal controls such indexes as.Results The level of serum HGF in HT group[(413.87±90.87)ng/L],and HT+T2DM group[(413.72±98.72)ng/L]were higher than that in control group[(120.45±25.11)ng/L](P＜0.05),but there was no significance between HT group and HT+T2DM group(P＞0.05).There existed a positive correlation between HGF and FBG,SBP(r=2.273,r=5.353,P＜0.05).Conclusion Higher levels of HGF is found in patients with hypertension and hypertensin complicated with T2DM,which indicates the severity of dysfunction of vascular endothelium.
ABSTRACT
Objective To observe the level of serum hepatocyte growth factor (HGF) in patients with impaired glucose tolerance (IGT). Methods Thirty patients with IGT (IGT group), 30 patients with type 2 diabetes mellitns (T2DM) (T2DM group) and 30 healthy controls (control group) were recruited for this study. Such indexes as HGF, fasting plasma glucose (FBG), postprandial plasma glucose (2hPG), glycosylated hemoglobin A1c( GHbA1c ), fasting insulin(FINS), systolic blood pressure(SBP), diastolic blood pressure (DBP) were examined and these related factors were analyzed. Results The levels of serum HGF in IGT group and T2DM group were higher than those in control group [(413.22 ± 102.48), (422.76 ± 126.77 ), ( 120.45 ± 25.11 ) ng/L, respectively ] (P < 0.05 ). There was no significant different between IGT group and T2DM group (P> 0.05). There was positive correlation between HGF and FBG (r = 0.326, P< 0.05 ). Multiple regression analysis indicated significant correlation between HGF and DBP (r = 4.730, P< 0.05). Conclusion Higher levels of HGF are found in IGT patients, which indicates that function of vascular endothelium is abnormal in this period.
ABSTRACT
Objective To explore the clinical therapeutic effects of St. John's Wort exact (SWE)on depressive disorder and blood glucose in elderly type 2 diabetic patients Methods 118 patients with type 2 diabetes and depressive disorder were randomly assigned to SWE group (26 cases),lorazepam group (22 cases ), psychotherapy group (24 cases), physicotherapy group (24 cases) and control group (routine therapy,22 cases) for 12 weeks' treatment. The clinical effects were evaluated with the percentage reduction in HAMD score after the treatment, HbAlc levels were obtained to monitor glycemic control. Results (1) The percentage reduction in HAMD score in SWE group was the highest (80. 8%), and it was lower in lorazepam group ( 63. 6%), psychotherapy group (62. 5%) and physicotherapy group(58. 3%). The percent decrease in H AMD score was higher in four groups than in control group ( 18. 2%) and the difference was significant (P < 0. 01). The therapeutic effect of SWE was better than the others(P0. 05). (2) The level of HbAlc in SWE group (6.5±0. 6)% was significantly lower than the others [( 7. 5 ± 0. 8) %, (7.4 ± 0. 8) %, (7. 4 ±1.0) % (P < 0. 01 )]. Conclusions St. John' s Wort exact (SWE) can efficiently improve the depressive disorder in elderly type 2 diabetic patients, and it is good for controlling blood glucose of the patients.
ABSTRACT
Objective To investigate the value of MR enteroclysis with air infusion in the diagnosis of small bowel disease.Methods Sixteen patients with suspected small bowel disease, but without acute inflammatory disease or bowel obstruction, received MR enteroclysis with air infusion.There were 12 males and 4 females, and their age ranged from 17 to 75 years.10 patients had abdominal pain, 4 with melena or blood stool, and 2 with diarrhea.The longest course was 7 years, and the shortest 1 week.Before MR imaging, a nasoenteric catheter was inserted into the distal part of duodenum, and about 1000 ml of air was infused through the tube to distend the small bowel.20 mg of IV anisodamine was given to reduce small-bowel peristalsis.All patients were imaged with fat-saturated Gd-DTPA enhanced coronal and axial T 1-weighted spin-echo (SE) sequence and fast spoiled gradient echo (FSPGR) sequence.Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed to assess the sensitivity and specificity of MRI.Results 5 cases were normal, 6 with Crohn disease, 2 with gastric intestinal stromal tumor (GIST), and 1 each of lymphoma, tuberculosis and irritable bowel syndrome.The lumen of normal small bowel in MR enteroclysis was no signal, the wall was outlined as middle signal by intraluminal air and surrounding air-distended bowel and was between 1-3 mm thick, and the diameter of the lumen was between 17-28 mm.Crohn disease showed segmental mural thickening, increased enhancement, luminal stricture, and even extraluminal inflammatory mass or fistula.Intestinal tuberculosis invaded the distal section of ileum, cecum, and the proximal ascending colon, the wall thickened and enhanced apparently, and cecum and proximal ascending colon shortened.GIST showed a mass that was iso-signal on T 1WI, high signal on T 2WI, and enhanced significantly after IV Gd-DTPA.1 recurrent lymphoma of ileum showed mural thickening and increased enhancement but no stenosis.1 irritable bowel syndrome is disfunction, so its shape and signal is normal.Except 1 Crohn disease, which showed a large mass, was misdiagnosed as lymphoma and no abnormality was found in 1 irritable bowel syndrome, the other diagnosis of MRI was correct.The sensitivity in diagnosing small intestinal disease was 100%, and the specificity was 83%.Conclusion MR enteroclysis with air infusion is a sensitive method in diagnosing the small bowel disease, especially in Crohn disease and tumor.It can clearly display the mural thickening and the extraluminal inflammatory mass.