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In recent years, immune checkpoint inhibitors are a milestone in the treatment of lung cancer. There are many kinds of immune checkpoints, which are closely related to the efficacy and drug resis-tance of immunotherapy, including programmed death-1 (PD-1), programmed death ligand-1 (PD-L1), cytotoxic T-lymphocyte antigen 4 (CTLA-4), killer cell immunoglobulin-like receptor (KIR), T cell immunoglobulin and ITIM domain (TIGIT), T-cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), etc. PD-1/PD-L1 inhibitors have been approved by China National Medical Products Administration and U. S. Food and Drug Administration for the first-line treatment of lung cancer, which can improve overall survival and progression-free survival of patients. The double immunotherapies of CTLA-4 inhibitors or TIGIT inhibitors combined with PD-1/PD-L1 inhibitors also achieve good results, however, more serious adverse events may occur.The KIR and TIM-3 targets are closely related to the drug resistance of immunotherapy.
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Objective:To investigate the stability and feasibility of improved silent MRA technique based on hybrid-arterial spin labeling(ASL) for imaging intracranial arterial stenosis.Methods:From September 2019 to May 2020, totally 35 patients with suspected intracranial vascular stenosis in Department of Neurology of Northern Jiangsu People′s Hospital were enrolled in this study. Silent MRA and improved silent MRA based on hybrid-ASL technique were performed respectively. The acquisition noise (noise measurement and subjective score) of two kinds of MRA examination were evaluated respectively. Two neuroradiologists performed image quality scoring and signal-to-noise ratio (SNR) measurement of intracranial arteries (including internal carotid artery, vertebrobasilar artery, anterior cerebral artery, middle cerebral artery, and posterior cerebral artery) in the two kinds of MRA images using a double-blind, completely randomized method. Independent sample t-test was used to compare the image quality and SNR of two kinds of MRA images in each segment. Two experts assessed the degree of stenosis at the site of confirmed intracranial artery stenosis. Kappa test was used to assess interobserver and intermodel agreement. Results:There was no significant difference in acquisition noise between improved silent MRA and silent MRA ( P>0.05). In all five segments measured, the image quality scores of internal carotid artery [(4.40±0.49)scores], anterior cerebral artery[(4.30±0.33)scores] and middle cerebral artery [(4.46±0.34)scores] in improved silent MRA were higher than those in silent MRA images [(4.02±0.43)scores, (4.02±0.31)scores, (4.02±0.31)scores; t=2.825, 2.877, 1.683, all P<0.05)]. The SNR of internal carotid artery (9.11±1.23) and middle cerebral artery (8.77±1.87) in improved silent MRA images was higher than that in silent MRA images (7.83±1.33, 8.06±2.67, respectively; t=11.154, 3.268, both P<0.05). A total of 24 patients (38 lesions) with intracranial vascular stenosis were diagnosed by CTA. Improved silent MRA (Kappa=0.89, 95%CI 0.82-0.95) and silent MRA (Kappa=0.85, 95%CI 0.77-0.92) were highly consistent among observers in evaluating the degree of cerebrovascular stenosis.The results of improved silent MRA were highly consistent with those of CTA (Kappa=0.92, 95%CI 0.87-0.98), and those of silent MRA were highly consistent with those of CTA (Kappa=0.85, 95%CI 0.77-0.92). Conclusions:The improved silent MRA is feasible to improve the imaging quality and signal uniformity through efficient marking based on keeping the low noise features. In the diagnosis of intracranial stenosis and occlusive disease, the stability of improved silent MRA imaging improves the diagnostic efficiency of stenosis to a certain extent.
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【Objective】 To compare the hemostatic effect and safety of single infusion of tranexamic acid with different loading dose before spinal surgery. 【Methods】 150 patients with scoliosis orthopaedic surgery were randomly divided into group C, group H and group L with 50 cases in each group. Before skin incision, group H and group L received intravenous loading dose TXA of 20 mg/kg and 10 mg/kg, respectively, followed by continuous intravenous pumping of TXA of 10 mg/kg/h until the end of the operation. Group C received intravenous infusion of 0.9% sodium chloride injection at the same time. Intraoperative infusion volume, blood loss, red blood cell transfusion volume, urine volume and postoperative drainage volume were recorded. Prothrombin time (PT), activated partial prothrombin time (APTT), D-dimer (D-D), blood platelet count (BPC), hemoglobin (Hb), hematocrit (HCT), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor -1(PAI-1) were detected before and after surgery. Adverse events such as lower extremity deep vein thrombosis (DVT), pulmonary embolism, acute kidney injury (AKI), epilepsy and myocardial infarction were followed. 【Results】 The amount of blood loss and transfusion in group H and group L was lower than that in group C (P0.05), while there was a significant decrease in PAI-1 in group C (P<0.05). B-ultrasonography of both lower limbs showed no DVT formation on 1d, 7d and 28d after surgery, and no adverse events such as pulmonary embolism, AKI, epilepsy and myocardial infarction were found after 28 d follow-up. 【Conclusion】 The application of high load dose of TXA in spinal surgery produces better hemostasis, and it has no effect on the incidence of near and long term postoperative adverse events.
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【Objective】 To investigate the effect of adequate amount of tranexamic acid(TXA)before operation on blood loss and safety in posterior lumbar fusion with multiple segments. 【Methods】 A retrospective analysis was conducted on 105 patients with lumbar spinal stenosis, submitted to our hospital for multilevel PLIF, from March 2017 to December 2019. According to the intervention method, they were divided into control group, group A and group B (n =30, 39 and 36, respectively). TXA was not used in the control group. Dripping of saline solution(100 mL) containing TXA 2g and 1g was given in Group A and Group B, and extra intravenous pumping of TXA [10 mg/(kg·h)] during surgery was conducted in Group B besides the pre-operation dripping of TXA. Total blood loss, dominant blood loss, recessive blood loss, intraoperative blood loss, postoperative drainage volume, transfusion rate and hemoglobin (Hb), hematocrit (Hct), prothrombin time international standardized ratio (PT - INR), platelet count (Plt), D - dimer (D - D), C-reactive protein (CRP), neutrophil percentage (NP), alanine aminotransferase (ALT), and blood urea nitrogen (BUN) before and after operation were compared in the three groups. Postoperative drug-related adverse events were traced. 【Results】 1)The total blood loss, dominant blood loss(mL), intraoperative blood loss(mL), drainage volume(mL) within and after 24h after surgery, and the transfusion rate(%) in group A and B were 892.6±193.5 vs 887.7±320.8, 409.1±109.2 vs, 408.6±98.3, 193.7±69.3 vs 189.6±65.6, 130.5±53.4 vs 128.3±53.5, 63.1±17.6 vs 60.9±13.5 and 7.7 (3/39) vs 8.3 (3/36), respectively, which were significantly lower than that in group C as 1 296.8±329.2, 807.6±231.5, 270.9±65.5, 365.4±127.8, 172.3±66.4 and 36.7(11/30), respectively (P< 0.05). There were no significant differences in the above indexes between group A and group B (P < 0.05). The differences in recessive blood loss was not significant by groups(P<0.05). 2) Compared with pre-operation, the levels of Hb, Hct and Plt in the three groups at 3d after operation decreased: Hb(g/L) 91.5±14.0, 107.6±16.4 and 105.9±17.1; Hct(%) 25.6±3.1, 31.2±3.9 and 30.5±4.4; Plt(×109/L)146.6±31.8, 172.8 ±40.1 and 169.7±39.5(P < 0.05); while D-D, CRP and NP increased: D-D(mmol/L)365.6±67.1, 280.9±50.5 and 286.1±53.1; CRP(mg/L): 65.4±22.0, 53.4±19.6 and 56.8±17.7; NP(%): 87.3±15.6, 73.1±13.7, and 71.9±11.8(P < 0.05), and Pt-INR, ALT and BUN showed no significant changes (P > 0.05). The changes of Hb, Hct, Plt, D-D, CRP and NP in group A and B were significantly lower than those in group C at 3 days after operation [Hb (g/L) : 107.6±16.4, 105.9±17.1, 91.5±14.0; Hct (%) : 31.2±3.9, 30.5±4.4, 25.6±3.1; Plt (×109/L) : 172.8 ±40.1, 169.7±39.5, 146.6±31.8; D-D (mmol/L) : 280.9±50.5, 286.1±53.1, 365.6±67.1; CRP (mg/L) : 53.4±19.6, 56.8±17.7, 65.4±22.0; NP (%) : 73.1±13.7, 71.9±11.8, 87.3±15.6] (P < 0.05), and no significant differences in the above index were noticed between group A and B(P> 0.05).3)No lower limb deep vein thrombosis nor pulmonary embolism were found in group A and group B after operation, and all the incisions were healed in the first stage, and no serious complications such as drug allergy, cardiovascular and cerebrovascular accident, epidural hematoma, epilepsy occurred. 【Conclusion】 The preoperative TXA administration with sufficient single dose showed equivalent hemostatic effect in comparison with intraoperative continuous administration additional to preoperative dripping, which is simple and convenient and does not increase the risk of thrombosis.
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Objective:To evaluate image quality and diagnostic performance of silent MR angiography (MRA) and discuss the feasibility of silent MRA in diagnosing intracranial aneurysms.Methods:Twenty seven patients suspected with cerebrovascular disorders and 30 intracranial aneurysms in Northern Jiangsu People's Hospital, were enrolled prospectively in this study from December 2015 to December 2018. Silent and time of flight (TOF) MRA were performed on the same day prior to CTA examination. The corresponding MRA images were independently and blindly evaluated by two experienced neuroradiologists in the aspects of signal homogeneity, lesion conspicuity, venous signal/artifact and diagnostic confidence (4-point scale). The aneurysms were divided into tiny (≤ 3 mm) and non-tinyaneurysm groups(> 3 mm) according to the measured diameters of aneurysms. The differences in image quality ratings between silent MRA and TOF MRA were analyzed using Wilcoxon signed rank tests. Intra-class correlation coefficients (ICC) were used to test the consistency of measurements between MRAs (silent MRA, TOF MRA) and CTA.Results:CTA revealed 32 intracranial aneurysms. For silent MRA and TOF MRA, the scores of signal homogeneity were 3.38±0.49 and 3.00±0.62, andthe scores of venous signal/artifact were 3.77±0.42 and 2.65±0.48.Significant differences were found between the two MRAs in these aspects ( Z=-2.21, P=0.02; Z=-5.69, P=0.01). The scores of lesion conspicuity were 3.19±0.56 and 3.15±0.46, and the scores of diagnostic confidence were 3.27±0.44 and 3.12±0.51.There were no significant differences found in these aspects ( P>0.05).The ICC coefficient was excellentfor silent MRA (0.94, 95%CI 0.82- 0.98)and was good for TOF MRA (0.72, 95%CI 0.30-0.91) in tiny aneurysm group. The ICC coefficient was excellent (silent MRA, 0.98, 95%CI 0.95-0.99; TOF MRA, 0.95, 95%CI 0.87-0.98) for both MRA in non-tiny aneurysm group. Conclusions:Compared with TOF MRA, silent MRA could achieve higher image quality and higher diagnostic confidence, and higher consistency with CTA. Silent MRA can be a promising non-contrast-enhanced alternative MRA technique in clinical setting.
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Objective:To explore the effect of Iowa evidence practice mode-based management program on the swallowing function in stroke patients.Methods:A total of 88 stroke patients in affiliated hospital of North Sichuan Medical College from April 2017 to April 2018 were recruited in the present study. Patients were randomly divided into experimental group (44 cases) and control group (44 cases) according to the random number table. The control group received routine nursing, while the Iowa evidence practice mode-based management program was carried our in the experimental group. After 30 days of intervention, the swallowing function was assessed by water swallow test, quality of life was evaluated by Short form of 36, the incidence of aspiration pneumonia was also compared between groups.Results:After intervention, the grade 1 patients in water swallow test were up to 29.3%(12/41) in the experimental group, and 18.6%(8/43) in the control group, the water swallow test was better in the experimental group compared to the control group ( Z value was 2.332, P<0.05). After intervention, the scores of vitality, social functioning, role-emotional, mental health were significantly increased in the experimental group compared to the control group (61.39±13.07, 60.44±10.89, 62.07±14.82, 64.78±15.24, 446.15±42.06 vs. 53.19±14.77, 50.09±13.15, 53.91±16.72, 57.81±16.34, 410.98±35.81), the difference was statistically significant ( t value was 2.018-4.133, P<0.01 or 0.05). The incidence of aspiration pneumonia was significantly decreased in the experimental group (2.4%,1/41) compared to the control group (16.3%,7/43), the difference was statistically significant ( χ2 value was 4.666, P<0.05). Conclusions:Iowa evidence practice mode-based management program can promote the swallowing function of stroke patients, as well as promote improve quality of life and decrease the incidence of aspiration pneumonia. It serves as an instruction for clinical intervention.
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Objective@#To study the overexpression of protein phosphatase 2 regulatory subunit B''α gene effects on the proliferation and invasion of hepatoma cells.@*Methods@#Immunohistochemistry method was used to analyze the expression of PPP2R3A in cancerous and paracancerous tissues. Hepatocellular carcinoma cell lines (Huh-7 and HepG2) with stably overexpressing PPP2R3A were constructed by lentiviral vector. Biological behavioral transition in hepatocellular carcinoma cell proliferation, cell cycle, apoptosis, invasion and metastasis were detected by cell counting kit-8 assay (CCK-8), flow cytometry, and transwell assay. A subcutaneous nude tumor mice model was constructed to validate the growth of hepatoma cells. Two independent sample t-tests were used to compare the groups.@*Results@#The expression of PPP2R3A gene in human hepatocarcinoma tissues was higher than paracancerous tissues. The absorbance (A value) of hepatoma cells was increased (P < 0.05) after overexpression of PPP2R3A gene. The transition from G1-to-S phase was significantly increased i.e., the G1 phase of the cell cycle was reduced (Huh-7: t = 3.04, P = 0.0384; HepG2: t = 4.06, P = 0.0153), while the S phase was increased (Huh-7: t = 3.47, P = 0.0255; HepG2: t = 4.46, P = 0.0112). Early apoptotic rate was decreased (Huh-7: t = 7.34, P = 0.0018; HepG2: t = 4.06, P = 0.0153). The number of Huh-7 cells migrating to the lower chamber was increased (t = 3.18, P = 0.0334), and after the use of matrigel the number of cells reaching to the lower chamber was also increased (t = 2.84, P = 0.0464). The results of animal experiments showed that the subcutaneous tumor growth (t = 4.31, P = 0.0035) was significantly overexpressed in nude mice group. The results of Western blot showed that the expression of PARP and P53 protein in the spliced forms decreased, while the accumulation of β-catenin protein in the liver cancer cells was increased.@*Conclusion@#Overexpressed PPP2R3A gene may promote proliferation, migration and invasion ability, inhibit apoptosis, induce G1/S phase transition, and participate in the biological behavior of hepatoma cells.
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Objective@#To investigate alterations of blood perfusion in subcortical regions in patients with Parkinson′s disease (PD) by three dimentional arterial spin labeling (ASL) magnetic resonance imaging (MRI).@*Methods@#Thirty patients with PD and 40 control subjects were recruited from the inpatient and outpatient of the Department of Neurology of Northern Jiangsu People′s Hospital during October 2014 to October 2016, and routine brain MRI and 3D pseudo-continuous pulse ASL were performed on all the subjects. The cerebral blood flow (CBF) maps derived from 3D ASL were coregistered to the Montreal Neurological Institute brain space. The stereo-templates of bilateral caudate nucleus, putamen nucleus, globus pallidum and thalamus from Anatomical Automatic Labeling were used as region of interest (ROI) to exstract absolute CBF values in these subcortical regions, respectively. The CBF ratio (rCBF) values represented by individual whole brain CBF divided by each of the regional CBF were also calculated in consideration of the difference between individual whole brain CBF. The CBF and rCBF values were compared respectively between groups by one-way analysis of variance.@*Results@#The subcortical CBF values (ml·100 g-1·min-1) for each ROI in PD (caudate nucleus (left: 35.32±6.47, right: 36.17±7.07), globus pallidum (left: 40.42±5.83, right: 40.18±5.70), putamen nucleus (left: 41.97±6.12, right: 42.91±6.43) and thalamus (left: 46.58±7.71, right: 49.11±7.10)) were significantly lower than that in the control group (caudate nucleus (left: 41.38±7.05, right: 41.63±6.85), globus pallidum (left: 45.65±8.35, right: 45.53±8.94), putamen nucleus (left: 48.49±8.78, right: 48.99±8.88) and thalamus (left: 54.32±11.94, right: 56.21±11.98), F=13.58, 10.56, 12.11, 10.06, 8.59, 8.23, 9.57, 8.30, P=0.000, 0.002, 0.005, 0.005, 0.001, 0.002, 0.003, 0.005, respectively). The whole brain mean CBF values of each subject were also extracted and compared bewteen groups, and mean CBF values (ml·100 g-1·min-1) in PD patients (42.14±9.61) decreased significantly than those in the control group (51.59±9.67, F=16.42, P<0.01), and there was a 18.31% decrement in whole brain mean CBF in the patient group. However, rCBF values for almost all subcortical ROIs of the patients significantly increased when compared with the control group.@*Conclusions@#The decreased absolute cerebral blood perfusion involved not only subcortical regions, but also the whole brain level in the course of PD. The CBF metabolism in patients with PD may have been redistributed, with relative hyperperfusion in the subcortical brain regions contrast to the whole brain perfusion level of patients themselves.
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Objective To investigate alterations of blood perfusion in subcortical regions in patients with Parkinson′s disease (PD) by three dimentional arterial spin labeling (ASL) magnetic resonance imaging (MRI). Methods Thirty patients with PD and 40 control subjects were recruited from the inpatient and outpatient of the Department of Neurology of Northern Jiangsu People′s Hospital during October 2014 to October 2016, and routine brain MRI and 3D pseudo?continuous pulse ASL were performed on all the subjects. The cerebral blood flow (CBF) maps derived from 3D ASL were coregistered to the Montreal Neurological Institute brain space. The stereo?templates of bilateral caudate nucleus, putamen nucleus, globus pallidum and thalamus from Anatomical Automatic Labeling were used as region of interest (ROI) to exstract absolute CBF values in these subcortical regions, respectively. The CBF ratio (rCBF) values represented by individual whole brain CBF divided by each of the regional CBF were also calculated in consideration of the difference between individual whole brain CBF. The CBF and rCBF values were compared respectively between groups by one?way analysis of variance. Results The subcortical CBF values (ml·100 g-1·min-1) for each ROI in PD (caudate nucleus (left: 35.32±6.47, right: 36.17±7.07), globus pallidum (left: 40.42 ± 5.83, right: 40.18 ± 5.70), putamen nucleus (left: 41.97 ± 6.12, right: 42.91 ± 6.43) and thalamus (left: 46.58 ± 7.71, right: 49.11 ± 7.10)) were significantly lower than that in the control group (caudate nucleus (left: 41.38±7.05,right: 41.63±6.85), globus pallidum (left: 45.65±8.35,right: 45.53±8.94), putamen nucleus (left: 48.49±8.78, right: 48.99±8.88) and thalamus (left: 54.32±11.94,right: 56.21±11.98), F=13.58, 10.56, 12.11, 10.06, 8.59, 8.23, 9.57, 8.30, P=0.000, 0.002, 0.005, 0.005, 0.001, 0.002, 0.003, 0.005, respectively ). The whole brain mean CBF values of each subject were also extracted and compared bewteen groups, and mean CBF values (ml·100 g-1·min-1) in PD patients (42.14±9.61) decreased significantly than those in the control group (51.59±9.67, F=16.42, P<0.01), and there was a 18.31% decrement in whole brain mean CBF in the patient group. However, rCBF values for almost all subcortical ROIs of the patients significantly increased when compared with the control group. Conclusions The decreased absolute cerebral blood perfusion involved not only subcortical regions, but also the whole brain level in the course of PD. The CBF metabolism in patients with PD may have been redistributed, with relative hyperperfusion in the subcortical brain regions contrast to the whole brain perfusion level of patients themselves.
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Clinical and imaging data of 11 patients with dysembryoplastic neuroepithelial tumors (DNET) and 15 patients with low-grade glioma (LGG) admitted in Northern Jiangsu People's Hospital were analyzed retrospectively.Routine MRI scan,diffusion weighted imaging (DWI) and enhanced scan were performed.The workstation automatically generated apparent diffusion coefficient (ADC) maps and then to obtain ADC values of the tumor parenchymal area and the contralateral normal reference area.Relative tumor/reference ADC values (rADC) were also calculated.The ADC values of parenchymal regions of tumor and contralateral normal reference areas and the rADC between DNET and LGG were compared.There was significant difference in age distribution between the two groups [(16.6± 13.1) vs.(43.0± 19.2) years,t=3.938,P＜0.01].Six out of 11 DNET cases and none of 15 LGG cases were cuneiform or fan-shaped (P＜0.01);5/11 DNET and 0/15 LGG showed circular high signal in fluid attenuated inversion recovery-T2 weighted imaging (T2FLAIR) sequence (P＜0.01),while there no significant differences in intracapsular segmentation,peritumor edema and mass effect,enhancement,and skull compression between two groups (all P＞0.05).The ADC values of tumor parenchymal regions in both groups were significantly higher than those in contralateral reference regions (both P＜0.01),the rADC of DNET was significantly higher than that of LGG (P＜0.01).It is difficult to identify DNET and LGG by conventional image morphology,however the rADC value of DNET in DWI is significantly higher than that of LGG,and can provide important reference for differential diagnosis between them.
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Objective To investigate the effects of down-regulating Cyclin D1 expression on Mdm2 gene expression and proliferation of human hepatoma cells.Methods Cyclin D1-siRNA was transfected into the hu man hepatoma cell line Hep3B s with liposome.The experiment was divided into the blank control group,negative control siRNA (NC-siRNA) group and Cyclin D1-siRNA group.RT-PCR and Western blot were used to detect the expressions of Cyclin D1,Mdm2,Mdm4,P53 and P21.The cell cycle was measured by flow cytometer;the cellular activity was tested with MTT;the cell apoptosis was examined by TUNEL.Results Compared with the blank control group and NC-siRNA group,the expressions of P53 and P21 in the Cyclin D1-siRNA group were increased (P＜0.05),while the expressions of Cyclin D1,Mdm2 and Mdm4 were decreased (P＜0.01);there were no significant differences in the G1,S and G2 phases among 3 groups(P＞0.05);the cell vitality in the in the Cyclin D1-siRNA group was significantly weakened compared with the other two groups(P＜0.01),while the cell apoptosis was significantly enhanced(P＜0.01).Conclusion The down-regulation of Cyclin D1 gene expression could inhibit the expressions of Mdm2 and Mdm4,and up-regulates the expressions of P53 and P21.Down-regulating Cyclin D1 expression can inhibit the proliferation of liver cancer cells and promotes their apoptosis.
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Objective To explore the efficacy of comfort analgesia and sedation in patients with mechanical ventilation in intensive care unit (ICU). Methods Eighty patients with mechanical ventilation admitted to ICU of Pingxiang People's Hospital from June 2017 to May 2018 were enrolled, and they were randomly divided into control group and observation group by random number table method, with 40 patients in each group. The control group was given a daily analgesic and sedation regimen with critical-care pain observation tool (CPOT) 0-3 and Richmond agitation-sedation scale (RASS) maintained at -3 to -4. The observation group was given comfort analgesic sedative scheme with immediate analgesia and sedation score, CPOT 0-1 and RASS -1-0. Under these circumstances, patients could be waken up at any time, feel comfortable and cooperate with treatment. The duration of mechanical ventilation, the length of ICU stay, ventilator associated pneumonia (VAP) rate, delirium rate and sedatives drugs usage were compared between the two groups. Results There were no significant differences in baseline data such as gender [male (cases): 25 vs. 28], age (years old: 55.2±8.3 vs. 56.1±7.9), acute physiology and chronic health evaluationⅡ (APACHEⅡ: 19.4±3.0 vs. 19.8±3.2) and etiology [sepsis (cases): 13 vs. 16, chronic obstructive pulmonary disease (cases): 12 vs. 10, acute lung injury (cases): 8 vs. 9, hemorrhagic shock (cases): 5 vs. 4, cardiogenic shock (cases): 2 vs. 1] between the observation group and the control group (all P > 0.05). Compared with control group, the duration of mechanical ventilation and the length of ICU stay were significantly decreased in observation group (days: 5.6±1.9 vs. 7.8±2.7, 6.6±2.1 vs. 9.8±2.5, both P <0.01), the VAP rate and delirium rate were significantly decreased (17.5% vs. 40.0%, 25.0% vs. 47.5%, both P < 0.05), the average dose and total dose of sedative drugs were significantly reduced [propofol average dose (mg): 200.3±94.2 vs. 455.7±143.1, propofol total dose (mg): 1 266.4±419.7 vs. 2 682.6±734.1; dexmedetomidine average dose ( μg):726.6±241.1 vs. 1 312.7±841.6, dexmedetomidine total dose ( μg): 5 647.3±2 215.2 vs. 9 864.5±4 268.0; all P < 0.01]. Conclusion The therapy of comfort analgesia and sedatives on ICU patients with mechanical ventilation, can decrease the treatment time, lower the risk of adverse events, and reduce the dosage of sedatives drugs.
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Objective To investigate the correlation between female age,menstrual status and the density of breast fibrous glandular tissue. Methods A total of 1 734 subjects with mammography examination were retrospectively analyzed,who were with 28 to 30 d menstrual cycle,or underwent natural menopause for more than 1 years,or with at least one side of the breast had no lesions,from October 2015 to August 2016 in Medical University Of Tianjin Cancer Hospital. At the same time, another 139 cases with mammography examination were treated as nonnatural menopause group, who received hysterectomy or postoperative chemotherapy of breast cancer. The breast fibrous gland tissue density of each subject was automatically calculated by the computer aided diagnosis system. One thousand seven hundred and thirty four subjects were divided into 4 groups according to age,including≤35 years old group(n=217),36 to 45 years old group(n=533),46 to 55 years old group(n=491),≥56 years old group(n=493),and was divided into premenopausal group(n=1 015)and natural postmenopausal group(n=719)according to the menstrual status.The premenopausal group was further divided into four subgroups:menstruation(n=158),one week after menstruation(n=311),two weeks after menstruation(n=316),and one week before menstruation(n=230). According to the status of menopause, the nonnatural postmenopausal group was divided into hysterectomy group(n=62)and drug menopause group(n=77)because of the postoperative chemotherapy of breast cancer. Pearson method was used to evaluate the correlation between age and breast fibrous glandular tissue density.A single factor analysis of variance was used to compare the differences in tissue density of subjects from different age groups and subjects from different menstrual status groups. The independent sample t test was used to compare the difference of the breast fibrous glandular tissue density between the premenopausal group and the natural postmenopausal group and between the nonnatural menopause group and the natural postmenopausal group.Results The tissue density differences of subjects from different age groups were statistically significant, and the tissue density of ≥56 years old group was lower compared to the other groups(P<0.05).A moderately negative correlation was presented between age and breast fibrous glandular tissue density(r=-0.456,P<0.01).The breast fibrous glandular tissue density of the premenopausal group was higher than that of natural postmenopausal group [(20.11 ± 8.54)% vs. (11.30±6.05)%,t=25.138,P<0.05].As to the different menstrual status,there was a significant differences between one week after menstruation subgroup and one week before menstruation subgroup(P<0.05).The density of fibrous glandular tissues in the hysterectomy group and the drug menopause group was(16.27± 6.91)% and(15.44±7.31)%, respectively. There was significant difference between drug postmenopausal group and natural postmenopausal group(t=-5.592, P<0.05). Conclusions Breast fibrous glandular tissue density decreases with the age. The breast fibrous glandular tissue density of the premenopausal women is significantly higher than that of natural postmenopausal women.The breast fibrous glandular tissue density of one week after menstruation is lower than that of the one week before menstruation.
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Objective To study the protective effect of lipoic acid (LA) on H9c2 cardiomyocytes hypoxia/reoxygenation injury model, and explore its relevant mechanism. Methods Eight strains of H9c2 cardiomyocytes, passaged after cultured to a full view, were divided into 3 groups:normoxia group, hypoxia/reoxygenation group and LA group. The cell survival rate, lactate dehydrogenase (LDH) activity, malondialdehyde (MDA) and heme oxygenase-1 (HO-1) levels were detected and compared. Results The cell survival rates of H9c2 cardiomyocytes in hypoxia/reoxygenation group and LA group were significantly lower than those in normoxia group:(52.86 ± 6.39)％, (69.25 ± 7.63)％vs. (92.31 ± 7.82)％, while the cell survival rate of H9c2 cardiomyocytes in LA group was significantly higher than that in hypoxia/reoxygenation group, and there were statistical differences (P<0.01). The LDH activity and MDA in hypoxia/reoxygenation group and LA group were significantly higher than those in normoxia group:(286.37 ± 27.49), (209.72 ± 25.63) U/L vs. (126.32 ± 18.94) U/L, and (1.72 ± 0.06), (1.13 ± 0.07)μmol/L vs. (0.68 ± 0.06) μmol/L, while those data in LA group were significantly lower than those in hypoxia/reoxygenation group, and there were statistical differences (P<0.01). The HO-1 in hypoxia/reoxygenation group and LA group were significantly higher than that in normoxia group:(213.71 ± 18.94)％, (367.26 ± 23.07)％vs. (87.92 ± 19.23)％, and HO-1 in LA group was significantly higher than that in hypoxia/reoxygenation group, and there were statistical differences (P<0.01). Conclusions The LA plays a protective role on myocardial cell with hypoxia/reoxygenation injurythough increasing the level of HO-1 against oxidative stress.
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Objective To further improve the awareness of the clinical feature of acute fibrinous and organizing pneumonia (AFOP).Methods One case of AFOP treated in our department was described in details.The relevant cases were searched in Wanfang database using key words acute fibrinous and organizing pneumonia [in Chinese].Results Four reports containing 9 cases were identified from published literature.A total of 10 cases (including this one) were analyzed.The patients included 7 males and 3 females (43 to 78 years of age).Eight patients presented with cough.Chest tightness and dyspnea were reported in 8 cases,and fever in 9 cases.Velcro crackles were heard in 4 patients.Laboratory tests showed WBC increased in 2 cases,increased neutrophil count in 6 cases,elevated C-reactive protein in 9 cases,and faster erythrocyte sedimentation rate in 8 cases.The partial oxygen pressure (PO2) ranged from 54 mmHg to 69 mmHg.Chest CT scan showed unilateral lesions in 3 cases and bilateral lesions in 7 cases initially.The main CT findings were patchy,consolidation and ground-glass opacities,sometimes associated with air bronchogram.The diagnosis was confirmed by lung biopsy in all the 10 cases.Bronchoscopy biopsy was conducted in 6 cases,and percutaneous lung biopsy in 3 cases.One patient received both bronchoscopy biopsy and percutaneous lung biopsy.Methylprednisolone was used in all cases.No patient received mechanical ventilation.One patient died.Conclusions AFOP is a new type of interstitial lung disease,the etiology of which is unknown.AFOP often occurs in middle-and old-aged patients.AFOP is easily misdiagnosed due to its unspecific clinical manifestations,which are similar to common pneumonia.The confirmation of AFOP diagnosis depends on pathological biopsy.Corticosteroids treatment is appropriate,but the dosage,duration,and long term effect of corticosteroids are not established.
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Objective To investigate the effects of narrow-band ultraviolet B (NB-UVB) therapy on the levels of plasmin and CC chemokine ligand 20 (CCL20) in peripheral blood of patients with psoriasis vulgaris.Methods A total of 60 patients with psoriasis vulgaris in progressive stage were treated with NB-UVB radiation thrice a week for 8 weeks.Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of plasmin and CCL20 in the peripheral blood of the patients before and after the treatment,as well as in the peripheral blood of 50 healthy controls.Results After the treatment,psoriasis area and severity index (PASI) scores in patients were significantly decreased compared with those before the treatment (2.54 ± 1.64 vs.10.26 ± 3.14,t =17.40,P ＜ 0.05),and the response rate was up to 87％ (52/60).Before the treatment,levels of plasmin and CCL20 were both significantly higher in the patient group than in the control group (plasmin:180.07 ± 40.62 μg/L vs.76.30 ± 26.92 μg/L,t =15.45,P ＜ 0.05;CCL20:422.41 ± 129.87 pg/L vs.205.33 ± 49.89 pg/L,t =11.15,P ＜ 0.05).After the treatment,levels of plasmin (148.22 ± 40.05 μg/L) and CCL20 (329.67 ± 100.73 pg/L) in patients were significantly decreased compared with those before the treatment (t =4.97,6.44,P ＜ 0.05),but still significantly higher than those in controls (t =10.82,7.95,P ＜ 0.05).Before the treatment,the level of plasmin was positively correlated with the level of CCL20 in peripheral blood of the patients (r =0.57,P ＜ 0.05),and the levels of plasmin and CCL20 were both positively correlated with the PASI score (r =0.49,0.62,respectively,both P ＜ 0.05).Conclusion NB-UVB radiation may exert a therapeutic effect on psoriasis vulgaris by reducing levels of plasmin and CCL20 in peripheral blood of patients.
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Objective To investigate the effect of calf serum therapy on patients with cerebral hemorrhage in patients with neurological impairment and rehabilitation.Methods 110 cases of cerebral hemorrhage patients from August 2014 to April 2016 in our hospital,were randomly divided into study group and control group using SAS10.0 software,each has 55 cases,two groups were given routine treatment measures of oxygen,dehydration,blood pressure,the study group also received deproteinized calf serum injection treatment,observe the clinical effect of two groups of the patients.Results Before treatment,the two groups had no statistical significance in patients with NIHSS score,BI index difference,for 14 days and 1 months after treatment,the study group of patients with NIHSS score were lower than the control group(P<0.05),the study group of patients with BI score were higher than the control group(P<0.05); the 14 day after treatment.Two groups of patients with cerebral edema were treated for 3 days were significantly reduced(P<0.05); after 3 months of treatment,the basic cure rate of group 58.18％,significant improvement rate was 27.27％,the control group were 40％,significant progress was 34.55％,compared the two groups,the study group than the control group(P<0.05).Conclusion The use of calf serum therapy in patients with cerebral hemorrhage is helpful to the recovery of neurological function and activity of daily living.
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Objective To observe the development of Schistosoma japonicum after single sexual infection and double sexual infection respectively. Methods A single Oncomelania hupensis snail was infected by a single schistosome miracidium. The lar?va were induced and released from the snail after 60?day incubation at 26℃. The mice were infected by the larva(single sexual infection)and dissected 40 days after the infection. All the worms were collected and the sex of the larvae was determined by the sex of the adult worms. Then,the mice and rabbits were infected by single sex of larvae(single sexual infection)and double sex of larvae(double sexual infection)respectively. The mice and the rabbits were dissected 40 days after the infection. All the worms were collected and measured under a microscope. Results All the male or female worms were collected from the mice and rabbits after single sexual infection. There were three main forms of worms after dissection of double sexual infection of mice and rabbits:folded mature male and female,male or female. Few folded male and immature female were found. Only the double sexual larva infected mice or rabbits had schistosome eggs in the liver and the liver had typical schistosome egg nodules. The sin?gle sexual larva infected mice or rabbits had no schistosome eggs or schistosome egg nodules in the liver tissues. The single male larva could develop to worms with the testis,and with a little smaller size compared to the mature folded male,while the single sexual infection female worm could not develop to the mature stage with much thinner and smaller compared to the mature folded female. Conclusions The male or female worms from single sexual infection are smaller than those from double sexual infection (mature worms?folded male and female). So it is necessary to check single sex worms in vessels of intestinal mucosa thoroughly in the sentinel mice when no schistosome eggs were found in the liver.
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Objective To investigate the degradation characteristics of the large-scale brain functional networks during aging by functional magnetic resonance imaging measurement and explore its intrinsic mechanism.Methods 40 healthy subjects including 20 elderly persons [mean aged(72.4 ±4.6)years] and 18 young persons [mean aged(23.9± 1.8) years] were enrolled in this study.All subjects underwent functional MRI scanning at blood oxygenation level-dependent contrast resting state.Four canonical resting-state networks,including the default mode network (DMN),dorsal attention network (DAN),executive control network (ECN),salience network,and visual network,were extracted by the seed zone and double regression methods.The functional connectivities in these canonical networks were compared between the young and elderly persons.Results Compared with young persons,the elderly showed the distinct and disruptive alterations in the large-scale aging-related resting brain networks.The impairment of ECN was the most serious,followed by the impairment of DAN.The salience networks and DMN showed relatively limited functional connectivity disruption.The networks associated to higher-order brain functions were impaired,while the visual network,which served as a network related to low-order brain functions,had no significant change.Conclusions The aged brain in healthy subjects is characterized by organized change in networks,and the selective impairments of large-scale brain networks were more significant in the networks associated to higher-order brain functions as compared with the networks related to low-order brain functions.
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Objective To summarize the clinical and pathogenic characteristics of urinary tract infection(UTI)in infants,and to provide reference for clinical diagnosis and treatment.Methods One hundred and eighty-eight cases of hospitalized infants with UTI diagnosis standard in Department of Pediatric Renal Rheumatism Immunology,Shengjing Hospital Affiliated to China Medical University from January 2012 to January 2015 were collected,and on the basis of the imaging they were divided into complex group(complicated UTIs) and non-complex group(non-complicated UTIs),the differences between 2 groups in the general condition,clinical manifestations,serological examination,urine culture and distribution of pathogenic bacteria and drug sensitivity results were analyzed.Results Among 188 UTI infants,148 were male and 40 were female,50 cases were in complex group (26.6％),and 138 cases were in non-complex group (73.4％).In complex group,the prevalence of prenatal ultrasound abnormalities (34.0％),the incidence of recurrent infections(24.0％),the number of fever incidence(78.0％),and peripheral WBC count [(16.4 ± 4.3) × 109/L] were higher than those in non-complex group[1.5％,10.9％,58.7％,(14.6 ± 3.5) × 109/L] (all P ＜ 0.05),and the naked eye hematuria incidence was lower than that of the non-complex group (14.0％ vs 34.8％,P =0.006).In complex group,pneumonia klebsiella bacteria positive rate was higher than that of non-complex group (22.0％ vs 2.9％,P =0.000),and the positive rate of Escherichia coli was lower than that of non-complex group(26.0％ vs 46.4％,P =0.000).There was no difference in the drug sensitivity and resistance of the pathogenic bacteria in the urine culture of 2 groups.Conclusions For fever,increased peripheral WBC,repeated infection and urine culture for Klebsiella pneumoniae UTI infants,in particular,should be alert to the prese-nce of urinary tract abnormalities,timely improve the urinary system ultrasound and urinary tract contrast is very necessary.