Extensive expansion of the chemical diversity of fusidane-type antibiotics using a stochastic combinational strategy

Fusidane-type antibiotics, represented by helvolic acid, fusidic acid and cephalosporin P

Value of radiofrequency ablation for perforating venous reflux / 中华普通外科杂志

Objective:To assess the value of radiofrequency ablation versus sclerotherapy for perforating venous reflux in the treatment of venous ulceration.Methods:This study included 56 patients with venous ulceration (C5/C6, 56 limbs) treated at Peking Union Medical College Hospital in 2018. The patients underwent radiofrequency ablation (Group A, 30 patients) or sclerotherapy (Group B, 26 patients) of perforating venous reflux.Results:The immediate success rate was 100%. During 1 to 12-month follow-up, 5 patients (1 in Group A and 4 in Group B) had recurrent venous ulcers. Recanalization of perforating veins was found in 8 patients (2 in Group A and 6 in Group B). The rates of free from venous ulcer′s recurrence in Group A and Group B were 92.6%±5.1% and 82.7%±8.0%, respectively. The rates of free from perforating vein recanalization were 88.4%±6.3 % and 61.5%±11.2% in Group A and Group B respectively. Univariate analysis of postoperative venous recanalization and ulceration recurrence revealed significant correlation between operation methods, perforating vein diameter and occurrence of adverse events. Specifically, radiofrequency ablation is associated with better outcome than sclerotherapy ( P=0.016), and perforating veins with diameter less than 3.5mm is associated with better outcome than those with diameter≥3.5mm( P=0.048). By multivariate regression analysis , operation type was the only risk factor of poor prognosis ( P=0.040). Conclusion:Radiofrequency ablation of perforating veins resulted in reduced rates of mid-term recanalization and ulceration recurrence compared with ultrasound-guided sclerotherapy.

Surgical treatment of malignant carotid body tumor / 中华普通外科杂志

Objective:To summarize the surgical treatment of malignant carotid body tumor (MCBT).Methods:A retrospective analysis of 14 MCBT patients admitted at our hospital from Mar 2005 to Nov 2019 was made, and the imaging data, surgical records, perioperative complications and follow-up data were collected.Results:There were 8 males and 6 females, with an average age of (40.8±11.3) years. 10 patients underwent surgical resection of CBT, with one case undergoing tumor enucleation only, nine cases underwent internal carotid artery reconstruction, and all patients underwent intraoperative lymph node biopsy.Tumors were completely removed in all 10 patients. No perioperative death or cerebral infarction occurred. The intraoperative blood loss was (955±658.5) ml. Four patients had permanent nerve injury after surgery. The follow-up time ranged 1-132 months. There were no cases of cerebral infarction or death, and the reconstructed graft remained patent. Apart from the 2 patients who developed tumor metastasis after surgery, other patients recovered uneventfully with no disease progression.Conclusions:Surgery is still the main treatment for MCBT, but MCBT is large and Shamblin class is more advanced. Therefore, complete tumor removal and reconstruction of the carotid arteries are difficult. Surgery should seek to completely remove the tumor and neck lymph node biopsy should be performed to determine the lymph node metastasis.

Evaluation of a new chromogenic media for the isolation and culture of Clostridium difficile / 临床检验杂志

Objective@#To evaluate the performance of a chromogenic agar developed by our laboratory for the isolation and culture of Clostridium difficile (CDCA). @*Methods@#The chromogenic specificity of CDCA was evaluated by inoculation of C. difficile and other standard strains, and the sensitivities of CDSA (BD), CDIF (BioMérieux) and CDCA were determined by the C. difficile standard strains respectively. A total of 120 clinical stool specimens were cultured for C. difficile by three chromogenic media respectively. The colonies were further identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and tpi gene was also detected. The sample which could be identified as C. difficile in any of the three chromogenic medium was defined as true positive. @*Results@#Most of standard strains were inhibited by CDCA, however some Clostridium species including C. clostridiiforme, C. bifermentans, C. tertium and Bacteroides fragilis grew lightly with chromogenic reaction. The sensitivities of CDSA, CDIF and CDCA were 2.0×105 CFU/mL, 8.0×101 CFU/mL and 4.0×10 2 CFU/mL, respectively. Among the 120 samples, 31 (25.8%) were defined as true C. difficile positive samples, while the positive rate of CDSA, CDIF and CDCA were 25 (20.8%), 28 (23.3%) and 26 (21.7%), respectively. There was no significant difference for clinical diarrhea specimens among the three chromogenic media (χ 2 =0.418, P=0.811). In comparison to the standard, the sensitivity, specificity, positive predictive value and negative predictive value were 83.8%, 100%, 100% and 94.7% for CDCA; 90.3%, 98.9%, 96.6% and 96.7% for CDIF; and 80.6%, 100%, 100% and 93.7% for CDSA. @*Conclusion@#The CDCA developed by our laboratory could be used to preliminarily isolate C. difficile with good specificity and sensitivity.

Emergent headache after carotid endarterectomy / 中华普通外科杂志

Objective To determine the incidence and clinical features of headache after carotid endarterectomy (CEA).Methods A retrospective analysis was made on the data of patients undergoing CEA in the Department of Vascular Surgery,Peking Union Medical College Hospital from Jan 2014 to Jan 2015.There were 119 males and 24 females,including 97 cases of symptomatic carotid stenosis and 110 cases of severe carotid stenosis.Results The incidence of newly emergent headache after surgery was 44％ (63/143).The earliest time of headache was 30 minutes after surgery and the latest was 6 days after surgery.95％ of headache occurred within 48 hours after surgery (60/63).79.4％ (50/63) of the headache lay ipsilaterally with CEA,and bilateral headache accounted for 20.6％ (13/63).Severe headache accounted for 4.8％ (3/63),all were ipsilaterally frontal and temporal headache,complicating central nervous system symptoms.Conclusions After CEA headache is a common clinical symptom.Most were mild to moderate and unilateral,which can be relieved spontaneously.Cerebral hemodynamics need to be further examined to differentiate the different pathological states of severe headache on the operative side after CEA because of the high risk of developing hyperperfusion syndrome or cerebral infarction.History of TIA or stroke is the risk factor of post-CEA headache.

Evaluation of clinical application of two molecular assays for detection of toxigenic Clostridium difficile / 中华检验医学杂志

Objective In comparison with Xpert C.difficile/Epi through detection of Clostridium difficile toxin genes from clinical stool , the performance of a laboratory-developed ( LD) assay was evaluated in detail.Methods A total of 176 stool specimens collected from patients with diarrhea in the First People′s Hospital of Yuhang District and the People′s Hospital of Yingzhou , Ningbo from August 1 to December 30 were detected by the two assays in parallel , and meanwhile the C.difficile strains will be isolated and identified for C.difficile toxin genes by a conventional PCR assay .The Cross-tabs Analysis was used for the results by using SPSS20.0 software.Results In comparison with the results of Xpert C.difficile/Epi as the standard, the LD assay had a sensitivity of 91.7％(22/24), a specificity of 100％(152/152), a positive predictive value (PPV) of 100％(22/22), and negative predictive value (NPV) 98.7％(152/154).The results of two assays were statistically coherent (Kappa=0.950, P<0.001).In comparison with culture and detection of toxin genes results , the LD assay had a sensitivity of 90.0％ ( 18/20 ) , a specificity of 97.0％(152/156), a PPV of 81.8％ (18/22), and NPV of 98.7％ (152/154)(Kappa=0.838, P<0.001), and the Xpert C.difficile/Epi assay had a sensitivity of 90.0％ (18/20), a specificity of 96.0％(150/156), a PPV of 75.0％(18/24), and NPV of 98.7％ (150/152)(Kappa=0.792, P<0.001). Conclusions The performance of the LD assay was similar to that of the Xpert C .difficile/Epi kit in detection of toxigenic C.difficile.The LD assay could be directly applied to detection of toxigenic C.difficile from clinical stool samples .The clinical application of this LD assay will also provide a domestic and promising diagnostic assay for diagnosis of C.difficile infection in China.

Evaluation of a real-time PCR assay for the qualitative detection of Clostridium difficile toxin gene and its clinical application / 中华检验医学杂志

Objective In comparison of the performances for the detection of Clostridium difficile toxin B genes from stool between BD MAX Cdiff assay and a laboratory-developed (LD) assay.The LD assay was evaluated in clinical application.Methods This study was a clinical application research.A total of 147 stool specimens from patients with diarrhea in Hangzhou First Hospital affiliated with Zhejiang Chinese Medical University were detected by the two assays from 1 July to 30 September 2014.DNA extraction and amplification of the tcdB gene were performed automatically on the BD MAX platform.Meanwhile, the tcdA and tcdB gene were detected by the LD real-time PCR assay after DNA extraction.Then, the results were analyzed by use of SPSS 10.0.Results A total of 147 stool samples were collected.There were 33 C.difficile positive cases and 114 negative cases detected by both of two assays.However, there were four stool samples had incongruent results.In comparison with BD MAX, the LD assay had a sensitivity of 93.94% (31/33), a specificity of 98.25% (112/114), a positive predictive value of 93.94% (31/33), and negative predictive value 98.25% (112/114).Furthermore, the results of the LD assay were statistically coherent with that of the BD assay (Kappa=0.922, P<0.01).Conclusions The LD assay was highly sensitive and accurate as BD MAX Cdiff assay in the detection of toxigenic Clostridium difficile.Furthermore, this LD assay could be also applied to detection of clinical stool samples directly with low cost.The assay will be more promising in diagnosis of toxigenic C.difficile in clinical application in China due to no additional instrument needed.

Influence of carotid body tumor resection on the blood pressure in essential hypertensive patients / 中华普通外科杂志

Objective To study the effect of CBT resection on blood pressure in essential hypertensive subjects.Methods Clinical data of 24 essential hypertensive patients (BP ＞ 140/90 mmHg or was using anti-hypertensive drugs) with CBT resection from May 2005 to March 2016 was analyzed,retrospectively.The heart rate,blood pressure were recorded continuously during the peri-operative and follow-up period.All of the patients were followed-up for at least 1 year.Results The systolic blood pressure(SBP) and pulse pressure (PP) decreased 1-3 months after the operation,and the difference was significant (P ＜ 0.001),while the diastolic blood pressure (DBP) and heart rate (HR) did not change significantly (P ＞ 0.05).Postoperative patients used less amount of antihypertensive drugs,but the difference was statistically not significant (P ＞ 0.05).Conclusions Unilateral CBT resection is associated with short-term to intermediate-term lowering of BP in hypertensive patients (P ＞ 0.05).

Influence of carotid body tumor resection on the blood pressure in essential hypertensive patients / 中华普通外科杂志

Objective To study the effect of CBT resection on blood pressure in essential hypertensive subjects.Methods Clinical data of 24 essential hypertensive patients (BP ＞ 140/90 mmHg or was using anti-hypertensive drugs) with CBT resection from May 2005 to March 2016 was analyzed,retrospectively.The heart rate,blood pressure were recorded continuously during the peri-operative and follow-up period.All of the patients were followed-up for at least 1 year.Results The systolic blood pressure(SBP) and pulse pressure (PP) decreased 1-3 months after the operation,and the difference was significant (P ＜ 0.001),while the diastolic blood pressure (DBP) and heart rate (HR) did not change significantly (P ＞ 0.05).Postoperative patients used less amount of antihypertensive drugs,but the difference was statistically not significant (P ＞ 0.05).Conclusions Unilateral CBT resection is associated with short-term to intermediate-term lowering of BP in hypertensive patients (P ＞ 0.05).

Efficacy evaluation of combined anterior-lateral approach for treatment of elbow triad injuries / 中华创伤杂志

Objective To discuss the surgical techniques and results of internal fixation supplemented with soft tissue repair of triad injury of the elbow via the combined anterior-lateral approach.Methods A retrospective analysis was done on 15 patients with triad injury of the elbow treated from January 2011 to August 2014.There were 10 males and 5 females,aged 38.4 years (range,20-61 years).Injury resulted from traffic accidents in nine patients,high-level falls in three and groundlevel falls in three.Radial head fractures were Mason type Ⅰ in five patients,type Ⅱ in eight,and type Ⅲ in two.Fractures of the coronoid process of the ulna were Regan-Morrey type Ⅰ in four patients,type Ⅱ in ten and type Ⅲ in one.Time interval between injury and operation was 8.5 d.All patients were firstly operated on through the anterior approach to have Herbert screw fixation or anterior capsule suture lasso fixation of the coronoid fracture as well as Herbert screw fixation of the radial head fracture.And then,elbow lateral incision was made to repair lateral collateral ligament complex and common extensor tendon by 2-0 Ethibon suture.Elbow flexion-extension,forearm pronation-supination and Mayo elbow performance score (MEPS) were used to evaluate the clinical elbow functions.Complications were recorded after operation.Results All patients were followed up for mean 19.6 months (range,12-30 months).All coronoid fractures healed.Radial head fractures in 14 patients healed.Comparison of preoperative to final follow-up variables presented significant differences in elbow flexion-extension [(45.1 ± 5.6) °:(129.5 ± 9.3) °],forearm pronation-supination [(55.4 ±.8.7) °:(140.5 ± 10.3) °] and MEPS [(25.1 ± 9.6) points:(91.2 ± 5.2) points] (P ＜ 0.01).Complications included heterotopic ossification in one patient and nonunion of radial head fracture in one patient.No neurovascular injury of the elbow,elbow residual instability,dislocation,elbow stiffness and active pain occurred.Conclusion Combined anterior-lateral approach with internal fixation and soft tissue repair is a simple and safe method that effectively restore the elbow joint function.

A vascular endothelial growth factor activating transcription factor increases the endothelial progenitor cells population and induces therapeutic angiogenesis in a type 1 diabetic mouse with hindlimb ischemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Therapeutic angiogenesis has been shown to promote blood vessel growth and improve tissue perfusion. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis. However, it has side effects that limit its therapeutic utility in vivo, especially at high concentrations. This study aimed to investigate whether an intramuscular injection of a genetically engineered zinc finger VEGF-activating transcription factor modulates the endothelial progenitor cells (EPC) and promotes therapeutic angiogenesis in a hindlimb ischemia model with type 1 diabetes.</p><p><b>METHODS</b>Alloxan (intravenous injection) was used to induce type I diabetes in C57BL/6 mice (n = 58). The ischemic limb received ZFP-VEGF (125 µg ZFP-VEGF plasmid in 1% poloxamer) or placebo (1% poloxamer) intramuscularly. Mice were sacrificed 3, 5, 10, or 20 days post-injection. Limb blood flow was monitored using laser Doppler perfusion imaging. VEGF mRNA and protein expression were examined using real-time PCR and ELISA, respectively. Capillary density, proliferation, and apoptosis were examined using immunohistochemistry techniques. Flow cytometry was used to detect the EPC population in bone marrow. Two-tailed Student's paired t test and repeated-measures analysis of variance were used for statistical analysis.</p><p><b>RESULTS</b>ZFP-VEGF increased VEGF mRNA and protein expression at 3 and 10 days post-injection, and increased EPC in bone marrow at day 5 and 20 post-injection compared with controls (P < 0.05). ZFP-VEGF treatment resulted in better perfusion recovery, a higher capillary density and proliferation, and less apoptosis compared with controls (P < 0.05).</p><p><b>CONCLUSIONS</b>Intramuscular ZFP-VEGF injection promotes therapeutic angiogenesis in an ischemic hindlimb model with type 1 diabetes. This might be due to the effects of VEGF on cell survival and EPC recruitment.</p>

Comparative analysis on the clinical application of antibiotics before and after hospital special rectification on antibiotics / 医学研究生学报

Objective The article was to promote the rational use of antibiotics by comparative analysis on antimicrobial us -age before and after the special rectification on clinical application of antibacterial drugs in our hospital . Methods Medical record data of 132 inpatients before the rectification and 167 inpatients after the rectification were randomly collected for the rational compara-tive analysis on microorganism submission rate for treatment , usage of antibiotics and medication for typeⅠandⅡincisions . Results The microorganism submission rate was much higher , especially the special grade antibiotics (81.5 %vs 32.1%).There was also a remarkable decrease in the percentage of antibiotics use , the strength of utilization and the average drug cost .The amount of antibiotic prophylaxis without indication and the length of medication for typeⅠincisions showed a remarkable decrease (P<0.05).Remarkable decrease was also observed in the irrational usage rate of antibiotic prophylaxis , dosage, medication time and drug replacement for typeⅠand Ⅱincisions (P<0.05). Conclusion The special rectification measures are effective and practical , which can promote the rational use of antibiotics .

Analysis on the rationality of using parenteral nutrition preparation in Nanjing General Hospital / 医学研究生学报

Objective Clinical parenteral nutrition( PN) support still lacks in standards on some degree .This paper was to analyze the clinical application of PN support in our hospital in order to provide the basis for clinical rational drug use . Methods Random weighting method was applied to collect 5% hospitalized patients′information from each patient unit each month from April 2012 to March 2013 in Nanjing Gerneral Hospital of Nanjing Military Region .NRS-2002 nutrition risk screening was applied to eval-uate whether the patient needed PN support .Statistical analysis were carried out on patients supported with parenteral nutrition from department distribution, PN detailed components and distribution intervals of aII in one admixture non-protein calorie and nitrogen ra-tio. Results According to the survey, 393 patients had received PN support, including 217 cases′NRS score <3 and 176 cases′NRS score ≥3.General surgery department ranked the first in the cases of usingall in oneadmixture support.Among 133 cases receiving all in one admixture support, the course of 37 cases(27.82%) <7 d.The aII in one admixture non-protein calorie and ni-trogen ratio(100~150∶1) only took up 28.57%. Conclusion Although PN has got wide application in clinical departments, the rationality of prescription should be strengthened .Pharmacists should help doctors set up appropriate prescription from the aspect of pharmacy.

Minimally invasive palmar locking plate for treatment of distal radius fractures / 中华创伤杂志

Objective To investigate the clinical effects,feasibility,points for attention and complications of treating distal radial fractures through minimally invasive palmar locking plate.Methods A total of 22 patients with distal radial fractures managed by minimally invasive palmar locking plate from August 2009 to August 2010 were enrolled in the study.According to AO classification,there were five patients with type A2 fractures,three with type A3,four with type B1,seven with type B3,two with type C1 and one with type C2.Two vertical or parallel palmar incisions of 2 cm long were performed.The distal transverse incision was along the proximal wrist crease,while the distal and proximal vertical incisions were close to the radial side of flexor carpi radialis.Then,palmar locking plate was inserted through deep pronator quadratus.Results Follow-up period was 10-18 months(mean,12 months).According to Dienst function evaluation criteria,the results were excellent in 13 patients,good in six,fair in three and poor in zero,with excellence rate of 86％.Complications were as follows:one patient had delayed healing of proximal wrist crease incision;one patient had numbness of thenar eminence and the symptom was disappeared three months postoperatively;two patients remained pain on ulnar side of the wrist joint;two patients had limited function of the wrist joint.Conclusions Minimally invasive palmar locking plate is safe,mini-invasive and reliable when treating distal radial fractures,which is conducive to early functional exercise.Furthermore,the method achieves satisfactory appearance of the incision which meets the minimal invasion and thus deserves clinical practice.

Perioperative anticoagulation or antiplatelet therapy in cases of carotid endoarterectomy / 中华普通外科杂志

Objective To evaluate the efficacy and safety of perioperative anticoagulation and antiplatelet therapy of carotid endoarterectomy (CEA). Methods A retrospective study on 110 cases (122 CEAs) of carotid stenosis between Jan 2004 and Dec 2008 was undertaken. 122 cases were divided into anticoagulation group and antiplatelet group according to the perioperative medical treatment. Postoperative results of stroke/death and wound hemotoma were compared between the two groups and statistically analyzed. Results 45 CEAs were given perioperative combination of anticoagulation and antiplatelet treatment. This comprised the anticoagulation group. The antiplatelet group consisted of the other 77 CEAs which were treated with antiplatelet solely. Perioperative stroke/death rates were equivalent (2.2% anticoagulation vs. 2.6% antiplatelet, P =0.897). Wound hemotoma rates were found with statistical significant difference between the two groups (13.3% anticoagulation group vs. 1.3% antiplatelet group, P = 0. 006 ). Conclusion Our results suggest that perioperative antiplatelet therapy in perioperative carotid endoarterectomy does not increase perioperative stroke/death risk, while perioperative anticoagulation increases the risk of wound hematoma.

Revascularization of lower limb artery ischemia for elder patients / 中华普通外科杂志

Objective To evaluate the result of revascularization for lower limb artery ischemia in elder patients. Method During Jan 2006 to Nov 2008, 262 elder patients (60 years old and up), underwent artery revascularization for lower limb arterial ischemia. Mortality, morbidity, primary patency, secondary patency and limb salvage were analyzed. Result There were a total of 323 ischemia limbs in those 262 elder patients undergoing revascalarization, among those 102 limbs underwent artery bypass, 98 limbs underwent endoluminal angioplasty with or without stenting, 67 limbs underwent embolectomy or endarterectomy, 56 limbs underwent open surgery combined with endoluminal treatment due to multiple segment lesions. Operation success rate was 94.7%. Two patients died within 30 days. Perioperative morbidity developed in 15 cases. 245 patients (93.5%) were followed-up from 1 month to 35 months. Mortality was 6.1% (15 cases), primary patency was 80.5%, secondary patency was 92.7% and limb salvage rate was 95.2%. Risk factors analysis showed that history of cardiac disease and elder ages were associated with higher mortality. Diabetes mellitus, critical ischemia and multiple segment lesions were associated with poor long term patency and limb salvage. Conclusion Lower limb ischemia is severe disease related to elder patients' death and amputation. Careful patient selection, detailed pre-operation work-up, meticulous operative technique play crucial roles for a successful arterial reconstruction.

Research developments on the biological activities of saponins / 医学研究生学报

This review summarized the biological activities of natural saponins,introduced its action mechanisms,clinical applications and research progresses in cardiovascular system,antitumor,immunological enhancement,blood sugar suppression,contraception,antifugal and insecticide,etc,and prospected its exploitations.

Evaluation of the pharmacoeconomics of alprostadil in pharmacotherapeutic schemes for cerebral infarction / 医学研究生学报

Objective:To investigate the curative effects and the economic effects of Alprostadil in Pharmacotherapeutic Schemes for Cerebral Infarction. Methods:118 cases of cerebral infarction, admitted from March 2001 to March 2003, were collected and divided into two groups: Alprostadil was given to group Ⅰ, Alprostadil was not given to group Ⅱ. Data was evaluated using the pharmacoeconomics cost effectiveness analysis. Results: The costs of two groups were 13 826.13 and 7 884.55 yuan respectively. The effective rates of two groups were 92.89% and 80.33% respectively. The cost-effective rates of two groups were 148.70 and 98.15 yuan / per unit of effective. It cost 469.69 yuan for group Ⅰ to increase per unit of effective above group Ⅱ. Conclusion: GroupⅡ had lower cost- effective ratio, and groupⅠ had higher effective rate. If patients care about effectiveness more than cost, it maybe useful to take groupⅠ.

Pharmacoeconomic evaluation of alprostadil in the pharmacotherapeutic scheme for cerebral infarction / 医学研究生学报

Objective:To investigate the clinical efficacy and economic effect of Alprostadil in the pharmacotherapeutic scheme for cerebral infarction.Methods:A total of 156 successfully treated cases of cerebral infarction were selected from those admitted from March 2003 to March 2004 and divided into two pharmacotherapeutic groups,with Alprostadil given to Group Ⅰ.The data were evaluated and compared by pharmacoeconomic cost-effect analysis.Results:The costs were $11 271.47 and $8 147.06,and the effectiveness rates were 84.21% and 70.00% respectively in the two groups,with the cost-effect ratios of 133.86 and $114.34 / unit effectiveness.It cost $219.87 for Group Ⅰ to increase a unit of effectiveness over Group Ⅱ.Conclusion:Group Ⅰ had a higher effectiveness rate,while Group Ⅱ a lower cost-effect ratio.

Practice of Ward Round Model of Clinical Pharmacists / 中国药房

OBJECTIVE:To explore the ward round model of clinical pharmacists.METHODS:The ward round model of clinical pharmacists was designed and explored based on clinical practice.RESULTS & CONCLUSION:Clinical pharmacists can engage in ward rounds either in cooperation with physicians or alone in special department,or by targeting at those patients using certain drugs.Each model has its distinctive characteristics and clinical pharmacists can choose suitable model based on their own level as well as the conditions in software,hardware and environment so as to facilitate rational administration.