ABSTRACT
Objective:To investigate the manifestations of liver injury in hospitalized patients with coronavirus disease 2019 (COVID-19), to investigate the prognosis indicators of the disease, and to provide the reference for clinical diagnosis and treatment.Methods:From January 10 to February 14, 2020, at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, the data of 333 hospitalized patients with COVID-19 were collected. The changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil) and albumin of the first liver function test after admission and the reexaminations of liver function test during hospitalization period in patients with liver injury were retrospectively analyzed. Student t test and Chi-square test were used for statistical analysis. Results:Liver injury occurred in 39.6% (132/333) of COVID-19 patients. There was no statistically significant difference in the rate of liver injury between patients in intensive care unit (ICU) and in general ward (45.6%, 26/57 vs. 38.4%, 106/276; χ2=1.026, P>0.05). 67.4% (89/132) of COVID-19 patients with liver injury presented with increased ALT or AST level on admission. During hospitalization, the level of ALT was higher than that of the first examination after admission ((60.28±50.44) U/L vs. (42.25±32.21) U/L), and the difference was statistically significant ( t=-3.230, P<0.05). The levels of ALT and AST of 71.2% (94/132) patients were both <80 U/L, which indicated that most of the patients showed mild liver injury. The patients with elevated level of TBil, DBil and IBil accounted for 3.9% (13/333), 5.4% (18/333) and 2.4% (8/333) of the COVID-19 patients, respectively. The albumin level of COVID-19 patients with liver injury during hospitalization was lower than that of the first examination after admission ((31.8±5.1) g/L vs. (33.7±5.4) g/L), and the difference was statistically significant ( t=2.712, P<0.05). The albumin levels at first examination on admission and reexamination during hospitalization of patients in ICU were both significantly lower than those of patients in general ward ((29.3±3.7) g/L vs. (34.8±5.1) g/L and (27.6±2.8) g/L vs. (32.9±5.1) g/L), and the differences were statistically significant ( t=4.928 and 4.783, both P<0.05). Conclusions:The incidence of liver injury in COVID-19 patients is high. A slight increase in aminotransferase levels is particularly common. Bilirubin abnormality is relatively rare and mild. The level of albumin may be one of the indicators for the severity and prognosis of COVID-19.
ABSTRACT
Objective: To explore the effect of differentiation of cardiac stem cells (CSC) mediated by pilose antler polypeptides on the expressions of terminal myocardial differentiation genes atrial natriuretic polypeptide (ANP) and myosin light chain 2v (MLC-2v), and to clarify the mechanism of repairing the damaged myocardium Methods: The healthy male Wistar rats born 2 d were selected to extract the CSC. The surface marker c-Kit and the purity of CSC were identified by immunofluorescence and flow cytometry. The culture dish was used as the experimental unit and the extracted cells were divided into the following four groups: blank control group (the same amount of buffer was added for induction), 5-azacytidine group (induced with 3 jumol · L-1 5-azacytidine), pilose antler polypeptides group (induced with 800 mg · L-1 pilose antler polypeptides) and combined group (induced with 800 mg · L-1 pilose antler polypeptides and 3 μmol · L-1 5-azacytidine); the cells were incubated for 48 h in the condition of 37°C and 5% CO2. The expression levels of ANP and MLC-2v in supernatant of the cells in various groups were detected by ELISA method. The expression levels of ANP and MLC-2v mRNA in the cells in various groups were detected by RT-PCR method. Results: CSC were prepared with the purity0.05). The result of RT-PCR showed that the expression levels of ANP and MLC-2v mRNA in 5-azacytidine, pilose antler polypeptides and combined groups were significantly increased compared with blank control group (P<0.05). Conclusion: Pilose antler polypeptides can induce the differentiation of CSC into cardiac cells by promoting the expressions of ANP and MLC-2v, and they can reduce the cytotoxicity induced by 5-azacytidine in some degrees.
ABSTRACT
Objective A finite element analysis was conducted on the biomechanics of the locking plate and intramedullary nail fixation for the treatment of distal tibial fractures,and the resuhs were verified combined with clinical cases,so as to provide references for clinical treatment.Methods (1) Finite element analysis:the three-dimensional CT data of the lower limbs of a healthy male volunteer were used to establish a finite element model.The internal stress distribution of the tibial plateau was set to 60％ of the total load by intramedullary nail and locking plate respectively,and the tibia end was fixed effectively.400 N axial pressure load which equaled to that of adult knee joint during single axis standing was simulated.The equivalent stress and displacement of the model by different fixations were compared.(2) Clinical verification:a retrospective case control study was performed on the clinical data of 37 cases of distal tibia1 fractures treated with internal fixation from June 2015 to December 2016,including 17 cases in intramedullary nail group and 20 in locking plate group.The operation time,intraoperative blood loss,postoperative fracture healing time,and postoperative Johner-Wruhs score of patients were recorded for comprehensive assessment of recovery.Results (1) The finite element analysis results:the maximum stress value was 5.907 MPa for intramedullary nail and 5.821 MPa for locking plate model (P ＞0.05),respectively.The maximum displacement of intramedullary nail model was 2.313 mm,lower than that of locking plate fixation system (3.854 rmm) (P ＜ 0.05).(2) Clinical verification:the operation time and intraoperative blood loss of intramedullary nail were both lower than those of locking plate [(114.1 ±21.6)minutes):(129.8±21.4)minutes and (152.9 ±64.88)ml:(212.5 ±98.5)ml](P ＜0.05).The average fracture healing time was (17.7 ± 2.8)weeks for intramedullary nail and (20.6 ± 4.1) weeks for locking plate (P ＜ 0.05),respectively.In the intramedullary nail group,the Johner Wruhs score was excellent in 13 cases and good in four cases,with excellent and good rate of 100％,while in the locking plate group,nine cases were excellent,eight were good,and three were fair,with excellent and good rate of 85％ (P ＞ 0.05).Conclusions In terms of biomechanics and clinical effect,intramedullary nail fixation is superior than the medial locking plate fixation for the treatment of the distal tibial fractures.Intramedullary nail fixation can reduce surgical trauma and bone displacement after fixation and promote fracture healing.
ABSTRACT
Objective:To explore the effect of differentiation of cardiac stem cells(CSC)mediated by pilose antler polypeptides on the expressions of terminal myocardial differentiation genes atrial natriuretic polypeptide (ANP)and myosin light chain 2v(MLC-2v),and to clarify the mechanism of repairing the damaged myocardium.Methods:The healthy male Wistar rats born 2 d were selected to extract the CSC.The surface marker c-Kit and the purity of CSC were identified by immunofluorescence and flow cytometry.The culture dish was used as the experimental unit and the extracted cells were divided into the following four groups:blank control group(the same amount of buffer was added for induction),5-azacytidine group(induced with 3 μmol·L-15-azacytidine),pilose antler polypeptides group(induced with 800 mg·L-1pilose antler polypeptides)and combined group(induced with 800 mg·L-1pilose antler polypeptides and 3 μmol·L-15-azacytidine);the cells were incubated for 48 h in the condition of 37℃ and 5% CO2.The expression levels of ANP and MLC-2v in supernatant of the cells in various groups were detected by ELISA method.The expression levels of ANP and MLC-2v mRNA in the cells in various groups were detected by RT-PCR method.Results:CSC were prepared with the purity>95%.The results of ELISA showed that the expression levels of ANP and MLC-2v in 5-azacytidine,pilose antler polypeptides and combined groups were significantly increased compared with blank control group(P<0.05).The expression levels of ANP and MLC-2v in combined group were increased compared 5-azacytidine and pilose antler polypeptides groups,but there were no significant differences(P>0.05).The result of RT-PCR showed that the expression levels of ANP and MLC-2v mRNA in 5-azacytidine,pilose antler polypeptides and combined groups were significantly increased compared with blank control group(P<0.05).Conclusion:Pilose antler polypeptides can induce the differentiation of CSC into cardiac cells by promoting the expressions of ANP and MLC-2v,and they can reduce the cytotoxicity induced by 5-azacytidine in some degrees.
ABSTRACT
Objective To investigate the rate of termination of pregnancy (TOP) in gravidas with prenatally diagnosed fetal malformation and to analyze the influences of medical and non-medical factors on decision making.Methods This was a prospective cohort study. Gravidas who took part in a multidisciplinary consultation due to fetal malformation and finished a questionnaire after consulting from September 12, 2012 to May 2, 2013 were recruited. Exclusion criteria were chromosomal disorders and isolated abnormal ultrasound soft markers. The questionnaire survey was conducted to understand the patient's backgrounds and to collect their feedbacks on the consultation. Decisions of the gravidas on TOP were followed up by phone in 2014 and 2016. If a gravida chose to continue her pregnancy, her baby's outcome was also recorded.T test,Chi-square test or Fisher's exact test, or rank-sum tests (Mann-Whitney or Wilcoxon) or Logistic regression was used for statistical analysis.Results (1) Altogether 229 gravidas were recruited and 10 of them were lost to follow-up, so 219 cases were finally analyzed. Among the 219 cases, 35.6% (78/219) chose to terminate their pregnancies. (2) Neonatal prognosis was predicted based on the type and severity of the disease and was divided into four levels including good prognosis (122 cases, 55.7%), medium prognosis (20 cases, 9.1%), poor prognosis (17 cases, 7.8%) and unsure prognosis (60 cases, 27.4%). (3) Gravidas who chose to terminate their pregnancies were younger than their counterparts choosing to continue to term (average age: 27.8±4.1 vs 29.0±3.9,t=2.257,P<0.05). Gravidas who went to the consultation before the 24th gestational week carried double risk of TOP than those after the 24th gestational week [termination rate: 52.5% (31/59) vs 29.4% (47/160),χ2=10.089,P<0.01). (4) Gravidas with fetal growth restriction (FGR) were at triple risk of TOP than those without (OR=2.850, 95%CI: 1.323-6.140) after adjusting for maternal age, gestational age at consultation and prognostic evaluation. Comparing with the good prognosis group, in which the rate of TOP was 19%, the unsure (OR=2.354, 95%CI: 1.108-5.004), medium (OR=16.188, 95%CI: 4.732-55.372) and poor (OR=14.515, 95%CI: 3.61-58.359) prognosis groups had higher risk of TOP. (5) There were 63 women informed us their reasons for TOP (multiple choices), among which 57 (90.5%) were due to unsure neonatal outcomes, and 10 (15.9%) were due to emotional factors. (6) Maternal satisfaction with neonatal prognosis was 2 to 5 points (medium score, ten-point system) lower in gravidas choosing to TOP than in those choosing to continue pregnancy regardless of good, unsure, or medium neonatal prognosis. No significant difference in maternal satisfaction was found among gravidas with poor neonatal prognosis.Conclusions The rate of TOP in gravidas with prenatally diagnosed fetal malformation remains high in China. Factors that can negatively influence the rate of TOP are consultation after the 24th gestational week, better perceived neonatal prognosis and higher maternal satisfaction with neonatal prognosis. Uncertainty of the neonatal prognosis is the leading cause of maternal dissatisfaction.
ABSTRACT
Objective:To observe the effects of Shen Hong Bu Xue Granule(SHBXG) on the expression levels of erythropoietin(EPO)mRNA in kidney tissue and granulocyte-macrophage colony-stimulating factor (GM-CSF) mRNA in bone marrow tissue of the mice with blood deficiency,and to investigate the protective effect of SHBXG on the blood deficiency mice and its mechanism.Methods:The mouse model of blood deficiency was established with acetylphenylhydrazine(APH) and cytoxan(CTX).A total of 60 mice were divided into blank control group,model group,Compound E-jiao Slurry group and low,middle,high doses of SHBXG groups(n=10).The serum,kidney and bone marrow tissues from all the mice were collected after 14 d consecutive administration.The levels of red blood cells(RBC),hemoglobin level(HGB),hematocrit(HCT),leukocytes(WBC),and platelet(PLT) in blood of the mice were detected by automatic blood analyzer;the levels of serum EPO and GM-CSF of the mice in various groups mice were detected by ELISA method;the expression levels of EPO mRNA in kidney tissue and GM-CSF mRNA in bone marrow tissue of the mice were detected by RT-PCR method.Results:The results of automatic blood analyzer showed that the levels of RBC,HGB,HCT,and PLT of the mice in Compound E-jiao Slurry group and different doses of SHBXG groups were increased significantly compared with model group (P<0.05 or P<0.01);the levels of WBC of mice in Compound E-jiao Slurry group and high dose of SHBXG group were increased significantly compared with model group(P<0.05).The ELISA results showed that the levels of serum EPO and GM-CSF of the mice in Compound E-jiao Slurry group and different doses of SHBXG groups were increased significantly compared with model group(P<0.05).The PC-PCR results showed that the expression levels of EPO mRNA in kidney tissue and GM-CSF mRNA in bone marrow tissue of the mice in Compound E-jiao Slurry group and middle and high doses of SHBXG groups were increased significantly compared with model group(P<0.05 or P<0.01).Conclusion:SHBXG could improve the blood deficiency symptom in the mice with blood deficiency,and its mechanism may be related to increasing the expression levels of EPO mRNA in kidney tissue and GM-CSF mRNA in bone marrow tissue of the mice.
ABSTRACT
Objective To investigate the clinical values of Gemstone Spectral Imaging coronary angiography with analysis of the relationship between plaque character and angina pectoris types.Methods Two hundred cases of hospitalized patients were collected from January 2015 to December 2016 in the Department of Cardiovascular Disease,Chenzhou City First People's Hospital,who were diagnosed as coronary heart disease.According to the clinical data,stable angina pectoris (SA) and unstable angina pectoris (UA),coronary CT scan was performed for each patient to evaluate the relationship between the nature of atherosclerotic plaques and the classification of angina pectoris.SPSS 19.0 software was used for statistical analysis.Results By analyzing the correlation between SA and UA,SA calcification plaque was accounted for 63.2％,soft plaque 17.4％,mixed plaque 19.4％;UA calcification plaque was accounted for 37.5％;Soft plaque was accounted for 42.3％;and mixed plate was accounted for 20.2％.The difference was statistically significant (P ＜ 0.05).In the SA group,all of the stenotic lesions were mainly calcified plaques.There was no significant difference in the degree of severe stenosis between the different plaques in the SA group (P ＞ 0.05).In UA group,soft plaques were the main lesion of mild and moderate stenosis of coronary artery,and calcified plaques were the main stenosis in severe stenosis.There were significant differences in the degree of coronary artery stenosis between different plaques in UA group (P ＜ O.05).Conclusions The 128-slice spiral CT can accurately evaluated the relationship between the nature of coronary plaque and the type of angina pectoris,which is of great value in the early warning and angina pectoris classification of high-risk patients with coronary heart disease.
ABSTRACT
BACKGROUND: Cardiac stem cells can differentiate into cardiomyocytes in vitro under induction of pilose antlerpolypeptides, which provides a new therapeutic idea for myocardial injury.OBJECTIVE: To explore the effect of pilose antler polypeptides on the apoptosis rate and membrane stability ofmitochondria in cardiac stem cells.METHODS: We chose healthy male Wistar rats born 2 days to extract cardiac stem cells. The culture dish was used asthe experimental unit, and extracted cells were divided into the following four groups (n=12). Blank control group: Thesame amount of buffer was added for induction; 5-azacytidine group: induced with 5-azacytidine (3 μmol/L); pilose antlerpolypeptides group: induced with pilose antler polypeptides (800 mg/L); combined group: induced with pilose antlerpolypeptides (800 mg/L) and 5-azacytidine (3 μmol/L). After 48 hours induction, apoptosis rate of cardiac stem cells ineach group was detected with flow cytometry. The membrane potential of mitochondria in cardiac stem cells wasdetected with immunofluorescence. The expression level of Nkx 2.5, GATA4, ATF-2, and MEF-2C in cardiac stem cellswas detected using western blot assay.RESULTS AND CONCLUSION: There were small, round and bright cells after 2 weeks culture, and cell colonies ofcardiac stem cells formed. The apoptosis rate of cardiac stem cells in the 5-azacytidine group increased significantly (P 0.05). The expression level of MEF-2C in each group was at a middle level, and there were no significantdifferences among groups (P > 0.05). To conclude, our experimental findings indicate that pilose antler polypeptidescould decrease the apoptosis rate and improve membrane stability of mitochondria in cardiac stem cells. Themechanism may be related to the increased expression of Nkx 2.5, but whether the mechanism is related to GATA4,ATF-2 and MEF-2C needs to be further studied.
ABSTRACT
Objective To construct evaluation system of residents standardization training's effect in Xinjiang. Methods According to the principles of combinations of comprehensiveness and direction, sci-entificity and operability, initial questionnaire regarding for residents' attitude, knowledge and ability was modified to form the final questionnaire through the first round of the survey using literature research and expert interviews. Internal consistency check was carried out for all valid questionnaires by SPSS 18.0, the reliability coefficient was calculated by Alpha test and the analytic hierarchy process was used to determine the indicators' weights of evaluation system of residents standardization training's effect in Xinjiang. Results The cronbach coefficient of the questionnaire was 0.894, with a higher reliability. Evaluation system of resi-dents standardization training's effect in Xinjiang included 6 first-level indicators and 23 second-level indi-cators, and calculated their respective weight coefficients. Conclusion Evaluation system of residents stan-dardization training's effect which was constructed and was in accordance with the reality of Xinjiang was more reasonable. It is of guiding significance to comprehensively and objectively measure the training effect of trainees and to strengthen and improve residents' standardization training in Xinjiang.
ABSTRACT
OBJECTIVE:To develop a method for simultaneous determination of psoralen,isopsoralen,bergapten,imperato-rin,trimethylpsorale,neobavaisoflavone and bavachin in Qing'e pills. METHODS:HPLC method was adopted. The separation was performed on Kinetex-C18 column with mobile phase consisted of methanol-0.1% glacial acetic (gradient elution) at the flow rate of 1.0 mL/min. The detection wavelength was set at 248 nm. The column temperature was 30 ℃. The sample size was 20 μL. RESULTS:The linear ranges were 1.012-101.2 μg/mL for psoralen(r=0.9999),1.007-100.7 μg/mL for isopsoralen(r=0.9997), 1.010-101.0μg/mL for bergapten(r=0.9999),1.021-102.1μg/mL for imperatorin(r=0.9999),1.002-100.2μg/mL for trimethyl-psorale(r=0.9996),1.008-100.8 μg/mL for neobavaisoflavone(r=0.9999),1.025-102.5 μg/mL for bavachin(r=0.9998),re-spectively. The limits of quantitation were 0.15,0.15,0.30,0.30,0.15,0.30,0.30 μg/mL,and the limits of detection were 0.05, 0.05,0.10,0.10,0.05,0.10,0.10 μg/mL,respectively. RSDs of precision,stability and reproducibility tests were lower than 2.0%. The recoveries were 95.3%-99.6%(RSD=1.9%,n=6),96.1%-99.3%(RSD=1.2%,n=6),95.2%-98.4%(RSD=1.4%,n=6),95.4%-99.2%(RSD=1.5%,n=6),96.1%-99.3%(RSD=1.5%,n=6),95.6%-98.9%(RSD=1.4%,n=6), 95.2%-99.6%(RSD=1.6%,n=6),respectively. CONCLUSIONS:The method is simple and accurate,can be used for simultane-ous determination of 7 kinds of components in Qing'e pills.
ABSTRACT
BACKGROUND: Compared with the metal screws, absorbable screws have more obvious advantages, such as does not have to conduct internal fixation removal, non-metal ic components, no influence on the magnetic resonance imaging of patients after implantation, relatively simple operations, namely dril ing-tapping-screws fixation, more in line with the principles of minimal y invasive in orthopedics. OBJECTIVE: To investigate the biomechanical characteristics of absorbable screw fixation in repair of simple lateral mal eolus fractures by means of finite element technology. METHODS: The three-dimensional model of simple lateral mal eolus fractures and absorbable screw model were established, and then fixed according to standard orthopedic surgical techniques. The reference load when the load bearing of fibulotalar joint reaching the peak value in a normal adult gait cycle was loaded. The stress distribution and displacement of fibula and absorbable screws were analyzed. RESULTS AND CONCLUSION: There were total y 38 542 units, 8 790 nodes in the single screw fixation model. When the articular facet of lateral mal eolus loading 300 N, the maximum stress of screws was 89.35 MPa, the maximum displacement was 0.5 mm, the maximum displacement of the distal fracture was 0.5 mm. When the articular facet of lateral mal eolus loading 450 N, the maximum stress of screws was 152.58 MPa, the maximum displacement was 0.59 mm, the maximum displacement of the distal fracture was 0.77 mm. There were total y 43 115 units, 9 496 nodes in the double screws fixation model. When the articular facet of lateral mal eolus loading 300 N, the maximum stress of screws was 38 MPa, the maximum displacement was 0.44 mm, the maximum displacement of the distal fracture was 0.44 mm. When the articular facet of lateral mal eolus loading 450 N, the maximum stress of screws was 66.68 MPa, the maximum displacement was 0.48 mm, the maximum displacement of the distal fracture was 0.49 mm. The experiment verified the biomechanical feasibility of absorbable screw fixation in repair of simple lateral mal eolus fractures. For simple involving only the lower lateral fibular fracture, absorbable screw fixation is entirely feasible, and usual y requires at least two screws to maintain the stability of the articular surface of the reset.
ABSTRACT
Objective Through investigating the current situation of first national Standardized Medical Resident Training Bases construction in Xinjiang to provide the basis for the administrative department of public health to improve their resident training bases.Methods Selecting standardized training related personnel 133 people of 20 base hospital to conduct a questionnaire survey,and selecting the base hospit.al leaders,the management staff of functional departments,teachers and residents,a total of 254 people were given in-depth interviews.We conducted data collection mainly around the basic situation of the base hospitals and departments,to understand the basic situation,difficulties and problems of the standardized training of resident doctors in the base hospitals,and suggestions and opinions on the training work.We used x2 test,Wilcoxon rank test to make statistical analysis.Results Basic conditions of the hospital was not balanced,70％ of the base hospital library number was 10 thousand ～5 million,75％ of the base hospital computer had a volume of less than or equal to 30.There was statistical significance in the difference of the rate of operation between the cases and the skills in the southem/northeru region teaching/non professional teaching base hospital.Teacher level was not balanced,and only 5 hospital teacher training rate was greater than or equal to 80％,which met the national requirements.Enrollment of each department had a rising trend,including the department of pediatrics,psychiatry and other major shortage of profes-sional year by year,the increase in the proportion of 1 ～2 times.National financial aid was implemented,but lacked local financial input.Conclusion The balanced development of base construction,the continuous improvement of system construction and organization management,the improvement of the teachers' teaching and training quality,the improvement of the resident treatment and striving for more national and local financial allocation will be the focus of the construction and development of Xinjiang resident standardized training base.
ABSTRACT
BACKGROUND:For unstable intertrochanteric fracture repair, there are two views:extramedul ary fixation or intramedul ary fixation. Theoretical y, intramedul ary fixation is in line with the principles of minimal y invasive, more mechanical and biological advantages. However, evidence-based medicine and related studies have shown that compared with the extramedul ary fixation, intramedul ary fixation did not reflect the proper theoretical advantage. OBJECTIVE:To compare the biomechanical performance of two kinds of internal fixation systems:dynamic hip screw and Gamma nail which commonly used in repair of intertrochanteric fractures by finite element method, and to evaluate the advantages and disadvantages of dynamic hip screw and Gamma nail in treatment of unstable intertrochanteric fracture. METHODS:Three-dimensional finite element model of human femur unstable intertrochanteric fractures (31-A2;AO fracture classification), and the three-dimensional finite element models of dynamic hip screw and Gamma nail were established respectively, and were fixed according to the requirement of orthopedic surgery. The reference load which the joint bearing was at the peak time in adult step state period with the body mass of 700 N was stimulated. The stress distribution of bone, bone-internal fixation model, nail or screw, the strain and deformation of fracture location on the surface of the bone and bone-internal fixation model, the stress distribution along the femur and the loading transfer condition along the internal fixator and the like were analyzed. RESULTS AND CONCLUSION:Dynamic hip screw and Gamma nail have good sliding compression features which could make the continuous and dynamical y axial compression of the fractured section. Under the load conditions, the displacement value of dynamic hip screw was larger. In the treatment of unstable intertrochanteric fracture, Gamma nail was stronger than dynamic hip screw. Two kinds of internal fixations al make the bearing load of the proximal femur reduce. In the treatment of 31-A2 type unstable intertrochanteric fractures, we should choose dynamic hip screw for fixation if the femoral calcar was not seriously crushed, little defect or no defects and can immediately rebuild the stability of femoral calcar during operation, otherwise, stronger internal fixation, namely Gamma nail fixation should be chosen.
ABSTRACT
Objective To investigate the clinical features and mechanism and feasibility of plasma exchange (PE) in treating systemic lupus erythematosus (SLE) complicated with acute pancreatitis (AP). Methods A retrospective analysis of SLE associated with AP was done based on the HIS in Tongji Hospital. Totally 24 SLEAP patients were admitted to Tongji hospital from March 2006 to May 2014. Patientsˊ serum amylase, lipase and interleukin (IL)-6 concentration were measured before and after plasma exchange. According to different therapy strategy, patients were divided into two groups. Fifteen patients treated with plasma exchange combination with glucocorticosteroid (GC) were classified as Group A, the other 9 patients who were treated with GC only were classified as group B. At baseline and after treatment, the serum lipid concentration, average daily glucocorticosteroid dosage between group A and B were compared with ANOVA and serum IL-6 concentration between roup A and B were compared with Wilcoxon rank test. Results SLEDAI score in group A patients at baseline (16 ±5) was no statistically different from that in group B (18 ±4) (t=1.31, P=0.320). Average daily GC dosage in group A 31.0 (20.50, 30.08)mg/d was significantly less than that in group B 47.85 (45.58, 59.23) mg/d (Z=35.50, P= 0.002). Serum IL-6 levels in group A and B at baseline was not significantly different 13.14 (11.12,16.57) mg/L vs 14.63 (11.37, 16.37) mg/L (Z=12.20, P=0.300), after 2 weeks treatment, IL-6 level, which was 9.16 (7.93, 10.75) mg/L, decreased significantly in group A while it didnˊt show tendency of decrease in group B, which was 13.62(9.29, 17.63) mg/L (Z=28.50, P=0.039). Serum lipid concentration after 2 weeks therapy in Group A [TC=(5.02 ±0.53) mmol/L, TG=(1.46 ±0.44) mmol/L] decreased significantly compared to baseline [TC=(6.11±0.50) mmol/L, TG=(2.14±0.65) mmol/L] (F=4.46, P=0.010; F=6.09, P=0.002), while similar tendency wasnˊt observed in group B (F=1.57, P>0.05). Conclusion PE combined with GC could lower serum IL-6 levels, reduce the amount of GC and lower serum lipid to improve prognosis. Therefore it might be a safe and effective way and is worthy of continuing to explore its feasibility.
ABSTRACT
Objective:To establish the quality standard for Chuipencao tablets. Methods:Sedum sarmentosum Bunge was identi-fied by TLC. Quercetin, kaempferol and isorhamnetin were determined by HPLC. Results: The method of TLC was highly specific. The linearity was obtained within the range of 4.94-98.82 μg·ml-1(r =0.999 9) for quercetion, 4.94-98.82 μg·ml-1(r =0.999 9) for kaempferol and 1.07-21.36 μg·ml-1(r=0.999 9) for isorhamnetion. The average recovery was 103.1%(RSD =2. 2%,n=6), 100. 6%(RSD=2. 0%,n=6) and 100. 1%(RSD=2. 0%,n=6), respectively. Conclusion: The method is accu-rate with good reproducibility, which can be used as the quality control for Chuipencao tablets.
ABSTRACT
Objective To investigate the treatment effects and toxicities of extended-field intensity modulated radiation therapy (EF-IMRT) and intra-cavitary brachytherapy combined with chemotherapy for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.Methods A total of 46 stage Ⅰ b1-Ⅳa cervical cancer patients with positive para-aortic lymph nodes treated at Fudan University Shanghai Cancer Center between 2009 and 2011 were reviewed.Neoadjuvant,concomitant and adjuvant chemotherapy with paclitaxel and carboplatin were administrated for one cycle before radiation therapy,two cycles during radiation therapy or three cycles after radiation therapy.All patients received EF-IMRT and intra-cavitary brachytherapy.The positive lymph nodes received an additional boost dose.Results All patients received EF-IMRT to 50.4 Gy (1.8 Gy per fraction).Twenty-six patients was treated with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to positive para-aortic lymph nodes.Thirty-seven patients received a positive paraaortic lymph nodes boost or(and) parametrial boost.All patient also received a high-dose-rate intra-cavitary brachytherapy at the point A dose of 20.0-30.0 Gy in 5.0 Gy per fraction.Total chemotherapy cycles were 189,and the average patient received 4.1 courses.Two cases (4％,2/46) experienced grade Ⅲ gastrointestinal toxicities,no patients suffered grade Ⅳ gastrointestinal toxicities.Fifteen cases (33％,15/46) experienced grade Ⅲ hematological toxicities,and 3 (7％,3/46) experienced grade Ⅳ hematological toxicities.Late grade Ⅲ-Ⅳ toxicity was seen in 3 cases (7％,3/46).The 3 year progressionfree survival rate was 46.2％,and the 3 years overall survival rate was 61.2％.Conclusion EF-IMRT and intra-cavitary brachytherapy combined with chemotherapy is safe and effective for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.
ABSTRACT
Background and purpose:More than 70 percent of ovarian cancer patients were diagnosed in the advanced stage. Currently the 5-year disease free survival (DFS) of stageⅢC-Ⅳovarian cancer patients wsa about 10 percent after first line chemotherapy. This study aimed to improve the 5-year DFS by three-step chemotherapy according to the mechanisms of ovarian cancer biological characteristics, cytodynamics and pharmacology. Methods:In arm A, the patients received three-step chemotherapy after primary debulking surgery, step one with paclitaxel plus carboplatin (TC regimen), every 3 weeks for 6 to 8 cycles;step two with etoposide plus cyclophosphamide, every 4 weeks for 6 cycles;step three wit carboplatin plus cyclophosphamide every eight weeks for six cycles. In control arm B, we retrospectively analysed 51 cases withⅢC-Ⅳstage ovarian cancer, who had completely response after standard chemotherapy with six to eight cycles of TC after primary surgery during 2007. We compared the 5-year DFS between the two arms. Results:The 5-year DFS of 15 cases in arm A was 80%(12/15), which was signiifcantly higher than that of arm B (5.9%, 3/51, P<0.01). Conclusion: The three-step chemotherapy after optimal debulking surgery in stageⅢC-Ⅳ can improve the 5-year DFS. This regimen is high efficacy, mild side-effect witn low cost, which deserves further exploration.
ABSTRACT
Objective To establish the reference ranges for fetal cardiac axis in the mid-second trimester and to evaluate the use of fetal cardiac axis in prenatal diagnosis.Methods 6744 unselected singleton pregnancies were enrolled from September 2008 to October 2010.Routine screening scan of second trimester and fetal echocardiography were performed at 18- 23+6 weeks gestation.Fetal cardiac axis was measured on the four-chamber view of the heart.Results The 6744 fetuses had a mean cardiac axis of (37.03 ± 6.10)°,ranging from 9.80° to 102.41°. Using above or below 95％ range of population (26.63° -49.40°) as a cut-off,there were significant difference of cardiac axis between normal group [(36.96 ± 5.91)°,P ＜0.01] and the group with heart defects [(43.12 ± 15.67)°,P ＜0.01],the group with intrathoricic anomalies or abdominal wall defect [(51.74 ± 15.97)°].ConclusionsThe reference ranges of fetal cardiac axis for local population in mid-second trimester may helpful for detecting congenital defects.Presence of an abnormal cardiac axis in the fetuses is associated with a substantial risk of congenital heart disease and/or other extra cardiac defects.
ABSTRACT
Objective To explore the clinical outcomes of the percutaneous radiofrequency nucleoplasty in the treatment of cervical disc herniation.Methods 183 patients with cervical disc herniation were treated with percutaneous radiofrequency nucleoplasty.A retrospective analysis of 183 patients was made,and their effects were evaluated using the VAS and the subjective satisfactory degree of the patients.Results All cases were followed up for 3 to 36 months( average 12 months).There were no complications observed such as hemorrhages,infections and nerve root injurys due to the procedure.One week after operation,symptom remission rate was 58.4％ and perfect rate of subjective satisfaction was 95.1％.At final follow up,symptom remission' rate was 66.1％ and perfect rate of subjective satisfaction was 85.8％.Conclusion Percutaneous radiofrequency nucleoplasty was an effective,minimally invasive and safe procedure to treat cervical disc herniation,and the operative treatment had shown better results.
ABSTRACT
Objective To study the protective effect of CMPS on alcohol/ CCL4 to liver injury.Methods Alcohol/CCL4 were given to rats to establish models of liver injury rats. The contents of AST, ALT, ALP, T-CHO, T-BIL, TP, ALB and A/G were determined by biochemical analyzer. The coments of SOD and MDA were by spectrophotometry. Results CMPS could reduce the levels of AST, ALT, ALP and MDA and raise the levels of ALB and SOD in mice model. Conclusion CMPS could protect liver injury. The mechanism may be related with its protection of cell membrane and antioxygen.