A new classification on location of hepatolithiasis in guiding treatment with percutaneous transhepatic choledochoscopic lithotripsy / 中华肝胆外科杂志

Objective:To study the clinical application of a new classification on location of hepatolithiasis in guiding treatment using percutaneous transhepatic choledochoscopic lithotomy (PTCSL).Methods:The clinical data of 85 consecutive patients with preoperatively diagnosed hepatolithiasis who underwent PTCSL at the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were prospectively collected. There were 27 males and 58 females, aged from 15 to 86(62±14) years. Hepatolithiasis was classified into five types of stone location based on preoperative imagings: type Ⅰ ( n=12) , stones located in central bile duct, including hilar bile duct and common hepatic duct; type Ⅱ ( n=17) in unilateral hepatic duct with multiple branches; type Ⅲ ( n=24) in unilateral hepatic duct with multiple branches plus central bile duct; type Ⅳ ( n=31) in bilateral hepatic ducts with multiple branches; and type Ⅴ ( n=1) in unilateral hepatic duct with a single branch. Fistulation path, number of procedures, number of bile duct fistula, and complications were recorded. The residual stone rate and stone recurrence rate were compared among the five types. The follow-up was performed to analyse prognosis. Results:A total of 99 biliary fistulae were performed, with one single tract created in 74 patients, two tracts in 9 patients, three tracts in 1 patient, and four tracts in 1 patient. The fistulation path was B2 in 12 patients, B3 in 18 patients, B4 in 1 patient, B5 in 4 patients, B6 in 10 patients, B7 in 4 patients, and B8 in 50 patients. Altogether, 151 choledochoscopic lithotomy procedures were performed (1-3 times per patient, mean 1.78 times). For the 9 patients with residual stones (10.6%, 9/85), there were 3 patients with type Ⅱ and 6 patients with type Ⅳ. There were significant differences in the residual stone rates among the 5 types (χ 2=11.13, P=0.025). Stone recurrence developed in 33 (38.8%) patients, including 2 patients with type Ⅰ, 7 patients with type Ⅱ, 10 patients with type Ⅲ and 14 patients with type Ⅳ (χ 2=9.07, P=0.046). The total intraoperative and postoperative complications rates was 28.2% (24/85). The follow-up period was 4-58 months with the median follow-up time of 30 months. Twelve patients died during the follow-up period, including 1 patient who died from postoperative bleeding, 3 cholangiocarcinoma, 7 biliary cirrhosis-related liver failure, and 1 stone-unrelated disease. Conclusion:Type Ⅳ in the location classification of hepatolithiasis based on PTCSL had significantly higher rates of residual stones and stone recurrence. This new classification is helpful for clinicaians to determine the optimal path using a smaller number of fistulation tracts to clear stones. It improved the efficacy of PTCSL in treating hepatolithiasis.

Clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation for the treatment of hepatolithiasis / 中华消化外科杂志

Objective:To investigate the clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation (PTCSL-OBF) for the treatment of hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 59 patients with hepatolithiasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2017 to December 2019 were collected. There were 16 males and 43 females, aged from 16 to 84 years, with a median age of 60 years. All patients underwent PTCSL-OBF. Observation indicators: (1) surgical and postoperative situations; (2) follow-up; (3) introduction of special cases. Follow-up using outpatient examination and telephone interview was performed to detect the hepotolithiasis-related symptoms, recurrence of hepatolithiasis , and survival of patients up to December 2019. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages. Results:(1) Surgical and postoperative situations: 59 patients underwent PTCSL-OBF successfully. Of the 59 patients, 48 cases had 1 biliary sinus tract, 8 cases had 2 biliary sinus tracts, 2 cases had 3 biliary sinus tracts and 1 case had 4 biliary sinus tracts. A total of 106 times of cholangioscopic lithotripsy procedure were performed in the 59 patients, including 20 cases with once of cholangioscopic lithotripsy procedure, 31 cases with twice of cholangioscopic lithotripsy procedure and 8 cases with 3 times of cholangioscopic lithotripsy procedure. Among the 59 patients, 14 cases were diagnosed with residual stones after operation, 45 cases had stones removed completely with the stones removal rate of 76.3%(45/59). The duration of hospital stay of the 59 patients were 24 days(range, 3-88 days). Of the 59 patients, 11 cases had 14 times of postoperative complications. The total incidence of complications was 18.6%(11/59). Among the 14 times of complications, there were 4 times of pleural effusion combined with infection, 2 times of liver abscess, 2 times of ascites, 2 times of intraoperative hypotension septic shock, 2 times of bleeding, 1 time of colon perforation and 1 time of bile leakage. Patients with complications were cured with symptomatic support treatment including puncture drainage, anti-infection and hemostasis. (2) Follow-up: 59 patients were followed up for 1-34 months, with a median follow-up time of 18 months. Of the 59 patients, 9 had recurrence of hepatolithiasis, with a recurrence rate of 15.3%(9/59); 17 had hepatolithiasis related symptoms, with an incidence of 28.8%(17/59). Of the 45 patients who had stones removed completely, 6 had recurrence of hepatolithiasis, with a recurrence rate of 13.3%(6/45); 14 had hepatolithiasis related symptoms, with an incidence rate of 31.1%(14/45). Of the 14 patients who had residual stones postoperatively, 3 had recurrence of hepatolithiasis, with an incidence rate of 21.4%(3/14); 3 had hepatolithiasis related symptoms, with an incidence rate of 21.4%(3/14). During the follow-up, 7 of 59 patients died, 2 of whom died of biliary neoplasms and 5 died of decompensated cirrhosis. (3) Introduction of special cases: among the 5 patients with biliary cirrhosis, 3 cases had stones removed completely, but the original symptoms of the 2 cases were not improved postoperatively and cholangitis occurred repeatedly. The other 2 cases underwent only once of cholangioscopic lithotripsy procedure because of severe cirrhosis combine with massive ascites.Conclusion:PTCSL-OBF can be used in the treatment of hepatolithiasis with appropriate indications, careful operation and strengthened perioperative management to reduce complications.

The clinical role of ultrasound image-fusion navigation system in percutaneous transhepatic cholangioscopic lithotripsy / 中华肝胆外科杂志

Objective:To study the clinical role of ultrasound image-fusion and navigation system (UIFNS), which works through image fusion with volume navigation of ultrasound (VNUS) and computed tomography (CT) or magnetic resonance imaging (MRI), in percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for treatment of hepatolithiasis.Methods:The data of 54 patients with hepatolithiasis who underwent PTCSL between January 2017 and October 2019 in Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University was retrospectively analyzed. Among 54 patients, 16 males and 38 females, aged 16-84 years with a median age of 59.5 years, were included. Preoperative ultrasound, CT, MRI and UIFNS were used to evaluate stone location and distribution in bile ducts. The rates of consistency of each single modality of evaluation with intraoperative examination by cholangioscopy plus ultrasound were compared. The stone clearance rates were compared among the different groups with different numbers of biliary sinus tracts used for stone extraction.Results:The rates of consistency of each single modality of evaluation, including ultrasound, CT, MRI and UIFNS, with intraoperative examination by choledochoscopy plus ultrasound were 75.9% (41/54), 55.6% (30/54), 72.2% (39/54) and 92.6% (50/54), respectively. The rates of consistency as assessed by UIFNS was significantly higher than that by CT or MRI (each P<0.05). The 54 patients were divided into the central-type group, the single-biliary-branch-type group and the multi-branch-type group according to biliary stone location and distribution, with 10 patients, 2 patients and 42 patients, respectively. Biliary sinus tract was established by the one-step method. One single tract was established in 43 patients, and two or more tracts in 11 patients. Each patient underwent 1-3 times of cholangioscopic lithotripsy (mean 1.76 times). The stone clearance rate in the central-type of patients and patients with single-biliary-branch stones was 100% (12/12). In 42 patients with stones in multiple branches of intrahepatic bile ducts, 31 patients underwent stone extraction through a single sinus tract while 11 patients through 2 or more sinus tracts. There was no significant difference in the stone clearance rate between patients with a single sinus tract and those with 2 or more sinus tracts ( P>0.05). The total stone clearance rate was 79.6% (43/54) and the total complication rate 18.5% (10/54). Conclusion:UIFNS was a useful tool with advantages in evaluating the location and distribution of biliary stones, and in selecting appropriate hepatic ducts for planning puncture routes to establish sinus tracts for stone removal.

Association of vascular cognitive impairment with acute cerebral infarction in different parts of the brain / 实用医学杂志

Objective To explore the correlation between acute infarctions in different parts of the brain and the risk of vascular cognitive impairment (VCI). Methods 212 patients with acute cerebral infarction were tested using Mini Mental State Examination(MMSE)and Montreal cognitive assessment(MoCA),and were divid-ed into normal cognition group,VCI group,vascular dementia group,and mixed dementia group. We analyzed the gender,age,past medical history,personal history,MMSE and MoCA scores,and imaging data. Results Of the 212 patients,61(28.77%)had normal cognition level,74(34.91%)had VCI,56(26.42%)had vascular demen-tia,and 21(9.91%)had mixed dementia. Multiple regression analysis showed that frontal lobe infarct increased the risk of VCI(OR,41.72)and vascular dementia(OR,48.49);cerebellar infarction also increased the risk of vascular dementia(OR,4.70)and mixed dementia(OR,12.38);and temporal lobe infarction increased the risk of mixed dementia significantly(OR,56.98). Conclusions Approximately 71.3%of the patients with acute cere-bral infarction develop vascular cognitive impairment. The infarcts occurring in the frontal lobe ,temporal lobe and cerebellum increase the risk of VCI significantly ,which should be given interventional therapies.

Changes of blood glucose and glycosylated hemoglobin in patients with progress of ischemic stroke / 中国综合临床

Objective To observe the changes of fasting plasma glucose (FPG) and glycated hemoglobin(HbAcl) in patients with progressive ischemic stroke(SIP),and to provide scientific basis for the prevention and treatment of SIP.Methods Two hundred and twenty-one cases of acute ischemic stroke in Aerospaceplane General Hospital of Beijing were enrolled in this study.They were divided into progressive ischemic stroke group(123 cases) and non-progressive ischemic stroke group(98 cases) according to the NIHSS score.The changes of FPG and FPG were observed and compared between the two groups after admission to the hospital.Results The incidence of diabetes in group SIP (51.22％,63/123) was significantly higher than that in non SIP group(15.31％,15/98),and the difference was statistically significant(P=0.000).The FPG and HbAlc of SIP group were (8.35± 3.76) mmol/L,(7.31 ± 2.07) ％,of non SIP group were (6.47± 2.86)mmol/L,(6.25± 1.31)％,the difference between the two groups was statistically significant (P =0.000).Distribution rate of FPG＜6.1 mmoL/L,6.1 mmol/L ≤FPG＜7.0 mmol / L,FPG≥7.0 mmol/L in SIP group patients were 38.21％,14.64％,47.15％ respectively,in non SIP group were 64.39％ and 16.33％,19.39％ respectively,the differences between the two groups were statistical significance(P=0.000).Distribution rate of HbA1c≤7.0％,7.0％＜HbA1c ≤.0％,HbA1c＞9.0％ of patients in the SIP group were 53.66％ (66/123),25.20％(31/123),21.14％(26/123) respectively,and in non SIP group were 79.59％(78/98),16.33％(16/98),4.08％ (4/98) respectively,the differences between the two groups were statistical significance (P =0.000).Conclusion The occurrence and development of SIP is not only related to diabetes,but also closely related to blood glucose and HbA1c levels.High blood glucose and high levels of HbA1c have important significance for early identification and prediction of SIP.

Case study of clinic facility layout optimization at public hospitals / 中华医院管理杂志

Hospital cases were collected from 18 hospitals regarding their clinic facility layout optimization when they implement the National Healthcare Improvement Initiative.These data were used to learn the implementation at such hospitals,and summarize problems and experiences of the Initiative,for reference of sustained improvements.

Procaine Attenuates Pain Behaviors of Neuropathic Pain Model Rats Possibly via Inhibiting JAK2/STAT3

Neuropathic pain (NPP) is the main culprit among chronic pains affecting the normal life of patients. Procaine is a frequently-used local anesthesia with multiple efficacies in various diseases. However, its role in modulating NPP has not been reported yet. This study aims at uncovering the role of procaine in NPP. Rats were pretreated with procaine by intrathecal injection. Then NPP rat model was induced by sciatic nerve chronic compression injury (CCI) and behavior tests were performed to analyze the pain behaviors upon mechanical, thermal and cold stimulations. Spinal expression of Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) was detected by qRT-PCR and western blot. JAK2 was also overexpressed in procaine treated model rats for behavior tests. Results showed that procaine pretreatment improved the pain behaviors of model rats upon mechanical, thermal and cold stimulations, with the best effect occurring on the 15th day post model construction (p<0.05). Procaine also inhibited JAK2 and STAT3 expression in both mRNA (p<0.05) and protein levels. Overexpression of JAK2 increased STAT3 level and reversed the improvement effects of procaine in pain behaviors (p<0.01). These findings indicate that procaine is capable of attenuating NPP, suggesting procaine is a potential therapeutic strategy for treating NPP. Its role may be associated with the inhibition on JAK2/STAT3 signaling.

Genistein antagonizes paraoxon-induced high expressions of NADPH oxidase p22phox and Nox4 in rat thoracic aorta tissues / 中国药理学通报

Aim To investigate whether genistein pro-tects paraoxon-induced vascular endothelial dysfunction through down-regulating p22phox and Nox4 expressions as well as inhibiting the generation of ROS.Methods In this study,thoracic aortas were isolated from the male Sprague-Dawley(SD)rats and were divided into the following groups:① control group,the thoracic a-ortas were incubated with dimethyl sulfoxide (DMSO, 0.1%)for 30 min;② genistein group,the thoracic a-ortas were incubated with genistein(100 μmol·L -1 ) for 30 min;③ paraoxon group,the thoracic aortas were incubated with paraoxon at the concentration of 40.5 μmol · L -1 for 30 min; ④ paraoxon plus genistein groups,the thoracic aortas were incubated with paraoxon (40.5 μmol·L -1 )plus genistein (100μmol·L -1 )for 30 min.The expressions of p22phox and Nox4 mRNA were detected by RT-PCR and the protein expressions ofp 2 2 phox and Nox4 were detected by Western blot.Results Compared with the control group,the expressions of p22phox and Nox4 were markedly increased in the paraoxon group. In the genistein group,the expressions of p22phox and Nox4 were significantly repressed. When treated with genistein plus paraoxon,there was a marked increase in the expression of Nox4(P <0.05),but no signifi-cant difference in the expression of p22phox.The ex-pression of p22phox in the paraoxon plus genistein group was significantly decreased(P <0.05)as com-pared with paraoxin group,but there was no significant difference in the expression of Nox4.Conclusion Paraoxon may result in oxidative damage of vascular endothelium through up-regulating p22phox and Nox4 expressions,genistein may down-regulate the expres-sions of both and protect vascular endothelium.

Bone filling mesh container for treatment of vertebral compression fractures can reduce the leakage of bone cement / 中国组织工程研究

BACKGROUND:By using the bone filing mesh container, a smal amount of bone cement can be penetrated to the trabecular space to form a microscopic twist, thereby strengthening the vertebral body. But there is no report about bone filing mesh container for treatment of osteoporotic vertebral compression fractures. OBJECTIVE:To compare the vertebral uplift and cement leakage of bone filing mesh container, percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of wedge-shaped osteoporotic vertebral compression fractures. METHODS:Ninety patients with wedge-shaped osteoporotic vertebral compression fractures were randomly divided into three groups. Polymethylmethyl acrylic bone cement type II was perfused into these three groups by bone filing mesh container, percutaneous vertebroplasty and percutaneous kyphoplasty, respectively. Bone cement type, vertebral uplift, leakage rate, visual analogue scale score, Oswestry disability index and Cobb’s angle were calculated and compared among the three groups. RESULTS AND CONCLUSION:The operation was successful in al patients. The success rate of puncture was 100%. There were 2 cases of bone cement leakage for percutaneous vertebroplasty and one case for percutaneous kyphoplasty. The vertebral uplift, visual analog scale score, Oswestry disability index and Cobb’s angle were improved significantly in the three groups after treatment (P 0.05). No difference in pain relief and action recovery was found among the three groups. These findings demonstrate that the bone filing mesh container with polymethylmethyl acrylic bone cement for treatment of osteoporotic vertebral compression fractures can have a promising result in relieving the pain, lifting the injured vertebral height, and the correction of kyphosis, which can also reduce the leakage rate of bone cement.

Impact of microwave dealing with the cutting surface on the hepatocellular carcinoma recurrence after hepatectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the impact of microwave dealing with cutting surface on perioperative liver function recovery and recurrence and metastasis after hepatectomy for HCC.</p><p><b>METHODS</b>Clinical data of 133 patients with HCC from March 2009 to November 2010 were retrospectively analyzed. They were divided into the conventional surgery group (66 cases) and microwave treatment group (67 cases). A domestic ECO-100 microwave knife was inserted into the liver cutting surface 0.5 cm from the cutting edge, and repeated multi-point burning with an average time of 25 minutes in the microwave treatment group. Then the perioperative liver function recovery and recurrence and metastasis in the two groups were compared.</p><p><b>RESULTS</b>The operation time of conventional surgery group was (158.0 ± 31.0) minutes, and that of microwave treatment group was significantly longer (181.0 ± 28.0) minutes (P=0.027). There were no significant differences in the liver function recovery between the two groups (P>0.05). There were 6 cases of recurrence and metastasis after 6 months and 9 cases after 12 months in the microwave treatment group, while there were 15 cases of recurrence and metastasis after 6 months and 20 cases after 12 months in the conventional surgery group, showing a significant difference (P=0.034 and 0.022, respectively).</p><p><b>CONCLUSIONS</b>Microwave dealing with the cutting surface has no significant effect on perioperative liver function recovery in hepatectomy. However, microwave treatment can reduce the in situ recurrence in HCC patients within the first year after surgery, indicating a good clinical application value.</p>

Challenges in the U.S.healthcare system and their implications for China / 中国卫生政策研究

This article discusses challenges in the current U .S.healthcare system and their fundamental cau-ses.Such challenges include increasing health expenditure , deficiency and excess in health service utilization , worse health outcomes than other developed countries , and insufficient GP numbers .We suggest that mistakes in early healthcare legislation and an imperfect health management system are the primary causes for these problems .Implica-tions for China ’ s current ongoing healthcare reform are outlined .We draw on the experience in the U .S.and other developed countries but keep China ’ s unique features in mind .Factors that need to be considered in China are ensu-ring the right of healthcare for all , giving full play to the role of government and primary medical institutions , strengthening support for GPs , reforming payment modes , controlling the growth of health expenditure , strengthening legislation, and handling medical accidents and disputes reasonably .

Clinical effects of gastrodin injection combined with fluoxitine in the treatment of post-stroke depression / 中国综合临床

Objective To investigate the therapeutic effects and adverse reaction of Gastrodin Injection combined with Fluoxitine (Prozac) in the treatment of post-stroke depression (PSD).Methods One hundred and two patients with PSD were randomly allocated into two groups:51 cases in the Gastrodin Injection and Fluoxitine combination group (treatment group),51 cases in Fluoxitine Group (control group).The treatment group was treated by intravenous injection of 600 mg/d Gastrodin (14 days) plus oral administration of 20 mg/d Fluoxitine (30 days).The control group was only treated by oral administration of 20 mg/d Fluoxitine (30 days).The therapeutic effects were evaluated by the observations of the changes of symptoms and signs and Hamilton Depression Scale (HAMD) respectively in the two groups.Results The cured,effective,improved and invalid rates were 9.8％ (5/51),52.9％ (27/51),27.5％ (14/51) and 9.8％ (5/51) respectively in the treatment group and 2.0％ (2/51),11.7％ (6/51),66.7％ (34/51) and 19.6％ (10/51) in the control Group.The total effective rate in the treatment and the control groups were 90.2％ (46/51) and 80.4％ (41/51) respectively.The therapeutic effect was better in the treatment group than in the control group,and there was significant difference observed between the two groups (x2 =13.03,P ＜ 0.05).The rate of adverse reaction was significantly lower in the treatment group than in the control group (3.92％ (2/51) vs.25.5％ (13/51),x2 =9.64,P ＜ 0.01).Conclusion Gastrodin Injection in combination of Fluoxitine,with low adverse reation rate,is an effective therapeutic method for the treatment of PSD.

Construction and identification of the replication defective adenoviral vectors carrying mouse SCp2shRNA / 中华肝胆外科杂志

Objectives It was constructed that the replication defective adenoviral vectors carried the short hairpin sequences of mouse SCP2.And we will make a further study of mechanism between SCP2 gene and cholesterol stone in gallbladder.Methods The short hairpin sequences of mouse SCP2 were cloned by two-step PCR,and connected together with the plasmid pDC312.The Admax Adenoviral Vector System was used to generate the replication defective adenoviral vectors,which were purified by CsCl method.The processes of TCID50 were applied to detect the titers of the adenoviral vectors.Furthermore,Protein levels of SCP2 were determined by Western blot analysis,and the levels of SCP2、CYP7A1、HMGCR mRNA from the hepa1-6 cell of mouse were measured by the usage of RT-PCR.Results SCP2mRNA and SCP2 protein were down-regulated by the replication defective adenoviral vectors carried the SCP2-shRNA.With the decreasing SCP2mRNA,the levels of HMGCRmRNA were down-regulated at same the time,while CYP7A1mRNA were up-regulated.Conclusions The replication defective adenoviral vectors carried SCP2-shRNA were constructed successfully.The lower levels of SCP2 could affect the activities of HMG-CoA reductase and CYP7-a enzyme,which caused the variations of cholesterol metabolism and then decreased the formation of cholesterol stone.

Data Envelopment Analysis-Based Evaluation of the Performance of Merger & Acquisition of Listed Pharmaceutical Companies / 中国药房

OBJECTIVE:To evaluate the performance of merger and acquisition (M&A) of listed pharmaceutical companies over 3 years from 2000 to 2002. METHODS: Based on the financial data of the listed companies in 26 cases, a data envelopment analysis was performed to compare and evaluate the efficiency of the companies before and after M&A. RESULTS: The efficiency was reduced in the first 3 years after M&A, but increased started from the fourth year. CONCLUSIONS: M&A did not promote the efficiency of listed pharmaceutical companies.

Effects of long time sedation with propofol on immune balance in severe sepsis / 中华急诊医学杂志

Objective To clarify the effects of sedation with propofol on pro/anti-inflammatory cytokines balance in severe sepsis patients resulted from intra-abdominal infection.Methods Fifteen patients with severe sepsis were randomly divided into two groups,propofol group received intravenous propofol sedation more than 48 hours,and no sedation drug were used in control group,3 volunteers as healthy group.Plasma TNF-?,IL-10 concentrations were measured at admission and 48 hours later,the ratio of TNF-?/IL-10 (T/I) were also calculated.Results Levels of both TNF-?,IL- 10 were significantly elevated in patients compared with healthy group,but no difference between prepofol and control group.The mean load doses of propofol was 0.063 mg/kg and maintained at 0.054 mg/(kg?h).After 48 hours infusion of prepofol,TNF-?,IL-10 decreased significantly compared with admission in propofol group,while no changed in control group.Compared with control group,IL-10 was lower and ratio of T/I was higher in propofol group.Conclusion Sedation with prepofol in severe sepsis patients attenuated the pro-and anti-inflammatory cytokine responses.Moreover, propofol accelerate the shift to Th1.These findings suggest that the influence of sedation drug on immune function must be considered in sepsis patients.

Phenotype and Genotype of Nosocomial Infection Strains of Klebsiella pneumoniae / 中华医院感染学杂志

OBJECTIVE To investigate the prevalence,antibiotic resistance and genotype of the extended-spectrum ?-lactamases(ESBLs)-producing clinical isolates of Klebsiella pneumoniae.METHODS A total of 104 isolates of K.pneumoniae were examined for the ESBLs production and the susceptibilities of the bacteria to 15 antimicrobial agents.PCR was performed to detect the genes encoding the ESBLs belonging to SHV and TEM families as well as CTX-M-1 and CTX-M-9 groups.RESULTS The ESBLs-producers of K.pneumoniae were 54.0% in the total of 104 isolates.Almost all of the ESBLs-producing isolates were resistant to the antibiotics commonly used,and only remained susceptible to carbapenems and the combination of cefoperazone with sulbactam.The genes of SHV,CTX-M-1 and TEM groups were detected in the ESBLs-producing isolates by 64.3%,46.4%,and 32.1%,respectively,and 35.7% and 8.9% of ESBLs-producing K.pneumoniae strains carried two and three genes.CONCLUSIONS The clinical isolates of K.pneumoniae in Tianjin Nankai Hospital are shown a high rate of ESBLs-producing and antibiotic resistance.SHV and CTX-M-1 groups of ESBLs are the dominant genotypes in the isolates of ESBLs-producing K.pneumoniae.

Intensive effect of traditional Chinese medicines activating blood to resolve stasis on medicines dredging intestines--influence on peristalsis of small intestine in guinea pigs / 中西医结合学报

OBJECTIVE: To observe the changes of peristalsis of small intestine in guinea pigs after administration of traditional Chinese medicines activating blood to resolve stasis (Compound Danshen Decoction, CDSD) or/and medicines dredging intestines (Dachengqi Decoction, DCQD), and to explore the synergetic or intensive effect of CDSD on DCQD. METHODS: By means of BL-420 Biological Experimental System, peristalsis of small intestine was recorded and analyzed following administration of DCQD, CDSD or Huoxue Chengqi Decoction (HXCQD, compound of CDSD and DCQD) respectively in different experimental periods. RESULTS: The amplitude and frequency of intestinal peristaltic wave obviously increased following administration of the three decoctions, but HXCQD appeared to be most dominantly. CONCLUSION: The effect of DCQD can be further enhanced by combining use of CDSD, suggesting that the traditional Chinese medicines activating blood to resolve stasis have an intensive effect on medicines dredging intestines.

The inhibition of apoptosis of hepatoma cells induced by HBx is mediated by up-regulation of survivin expression / 华中科技大学学报（医学）（英德文版）

To investigate the effect of HBx on expression of survivin in hepatoma cells and mechanisms of inhibition of apoptosis on hepatoma cells induced by HBx, the expression plasmid pHA-HBx encoding full length of HBx was transfected into HepG2 cells and the transformed cells were identified by RT-PCR. The expression of survivin both in HepG2 cells and HBx-transfected cells was examined with RT-PCR. The nude mice model of hepatoma was established by injecting HepG2 cells and HBx-transfected cells into the flank of nude mice subcutaneously. The expression level of survivin both in HepG2 formed tumors and HBx-transfected cell-formed tumors in nude mice was examined with Western-blot. The TUNEL assay was used to detect the apoptotic cells of tumor tissues in nude mice after intraabdominal chemotherapy with adriamycin. The results indicated that the amplification of survivin in HBx-transfected HepG2 cells was up-regulated when compared with that in non-transfected cells. Western-blot showed that the tumor cells expressing HBx in nude mice had a positive band of survivin expression and the tumor cells without HBx expression had no positive band. The result of TUNEL assay showed that there were less apoptotic cells in tumor tissues expressing HBx than that in control group cells. It was concluded that HBx could up-regulate the expression of survivin in hepatic carcinoma cells, which can inhibit apoptosis of hepatic carcinoma cells induced by adriamycin.

Detection of aberrant p16 methylation in the serum of colorectal cancer patients / 中华预防医学杂志

<p><b>OBJECTIVES</b>To detect aberrant p16 promoter methylation in serum of patients with colorectal cancer (CRC), and to explore the possibility of using this assay in early detection or as a prognostic marker.</p><p><b>METHODS</b>Methylation-specific PCR was used to detect p16 methylation in DNA extracted from 52 CRCs and corresponding serum samples. Serum samples from 34 patients with adenomatous polyps and 10 healthy individuals were used as controls. The association of p16 hypermethylation in serum DNA of CRC patients with clinicopathological characteristics was analyzed.</p><p><b>RESULTS</b>p16 methylation was found in 38% (20 of 52) of CRC tissues. Among the 20 patients with aberrant methylation in the tumor tissues, similar changes were also detected in the serum of 14 (70%) patients. No methylated p16 sequences were detected in the peripheral serum of the 32 CRC patients without these changes in the tumor, in 34 paitents with adenomatous polyps, or in 10 healthy controls. Clinicopathological analysis revealed that p16 methylation in serum was significantly associated with later Dukes' stage (chi(2) = 5.7, P = 0.03).</p><p><b>CONCLUSION</b>This assay offers a potential means for the serum-based detection and/or monitoring of CRC patients.</p>

TELOMERASE ACTIVITY AND DNA PLOIDY IN GASTRIC CARCINOMA AND ITS CLINICAL SIGNIFICANCE / 肿瘤研究与临床

Objective:To investigate the relationship between telomerase activity and DNA ploidy in gastric carcinoma.Methods:Telomerase activity was detected using telomerase repeat amplification protocol(TRAP),and image cytometry(ICM) was used to examine the DNA ploidy.Rusults:The total positive rate of telomerase in gastric carcinoma was 81.25%.The telomerase positive rate in early stage and advanced stage were 55.5% and 87.2% respectively.Aneuploid tumors tend to be telomerase positive.Conclusion:The telomerase activity is correlated with the progression and aneuploid rate in gastric carcinoma.