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To find an effective method of minimally invasive treatment combining prevention and assistance in the middle zone of conservative treatment and fusion surgery for lumbar degenerative diseases, through the clinical effect observation and the advantage and disadvantage comparison of several commonly used lumbar interspinous dynamic stabilization systems, by analyzing the physiological structure, biomechanics and relevant data of lumbar interspinous processes, based on fully understanding of memory alloy materials, a new dynamic lumbar interspinous fixation device with a memory alloy material has been independently designed and researched, which can not only reconstruct the normal biomechanical characteristics of the lumbar spine and satisfy the normal activities of the human spine, but also avoid damage to the original structure and reduce the incidence of postoperative complications. In addition, the device can be used to optimize the current therapeutic methods. According to our research, the dynamic lumbar interspinous process stabilization device with a memory alloy has theoretically achieved satisfactory results, which can be used to overcome the shortcomings of the existing technology and is superior to the current several dynamic lumbar interspinous process stabilization systems.
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Humans , Alloys , Biomechanical Phenomena , Lumbar Vertebrae/surgery , Postoperative Complications , Prostheses and Implants , Spinal FusionABSTRACT
Targeted therapy is one of the conventional treatments for advanced hepato-cellular carcinoma (HCC). In recent years, immunotherapy has created a new era of HCC treatment. The combination of targeted therapy and immunotherapy has synergistic effects, which taking survival benefits to patients with advanced HCC. Local therapy, represented by interventional treatment, can rapidly control the development of tumor and promote the expression and releasing of tumor antigen. On the basis of local therapy and combination of immunotherapy plus targeted therapy, it can offer the possibility to prolong the survival of patients, and even obtain the chance of cure. The authors introduce the diagnosis and treatment of an advanced HCC patient with inter-ventional treatment combined with immunotherapy plus anti-angiogenesis targeted therapy. Results show that patient achieving pathological complete response and undergoing resection after conver-sion therapy. The patient has a good prognosis with a better quality of live.
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Objective:To investigate the implementation procedures and dosimetric verification of the first patient treated with total body irradiation (TBI) based on volumetric modulated arc therapy (VMAT).Methods:Two sets of CT images were acquired under the head-in first and foot-in first to contour the planning target volume (PTV) of the cranial and caudal segments to accomplish the treatment of the whole body length, on which two interrelated plans of 5 subsequent isocenters with a total of 15 VMAT fields were performed to cover all PTVs. The plans were prescribed to ensure 90% PTV dose coverage with a total dose of 12 Gy in 6 fractions. Firstly, a dose optimization was performed on the caudal CT images, then the cranial CT images were optimized based on the dose distribution of the caudal CT images. The evaluation of the final treatment plan was carried out based on a plan sum of both two sets of images. The parameters of PTV and organs at risk (OARs) were measured by dose volume histograms from the accumulated plan. The quality assurance comprised the verification of the VMAT plans for each individual isocenter via Delta4 phantom. The dose distribution in the overlapped region between two adjacent central fields was verified with EBT3 film. The absolute dose at the overlapped region between two images was measured via Pinpoint chamber. In vivo dosimetry on the patient′s skin was monitored by MOSFET dosimeters. The results of planning parameters and treatment duration were analyzed. Results:The mean doses of two segments of PTVs were 12.45 Gy and 12.37 Gy. The mean dose for the lung was 10.8 Gy. The machine unit (MU) and mean treatment delivery time were 2 883 MU and 24.3 min, and the mean total time per fraction was 121 min. The mean 3%/3 mmγ-analysis pass rate for each isocenter VMAT plan was (99.74±0.42)%, and the mean 5%/5 mmγ-analysis pass rate for the overlapped region was (90.11±2.72)%. The average deviation of absolute dose in the overlap region of the caudal and cranial images was (3.6±0.4)%. In vivo measurement of 8 points on the patient showed that the dose of each region was ranged from 1.57 Gy to 2.04 Gy. Conclusion:According to the results of dosimetric verification, TBI based on multi-isocenter VMAT can be applied in clinical practice, which remains to be improved in terms of dose distribution, measurement results and clinical efficiency.
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Objective:To investigate and determine the epidemic scope of plague natural foci in Yulong County of Yunnan Province, and to assess its epidemic risk, so as to providing basis for monitoring, prevention and control of plague.Methods:In 2017, 2 - 3 natural villages were selected from 8 villages and towns in Yulong County according to geographical landscape, altitude, population and area. During October and November, small mammal hosts and their parasitic fleas were captured by the night trap (cage) method, Yersinia pestis was isolated from host animal organs, and plague F1 antigen and antibody were detected by colloidal gold test. Plague specific antigen was detected by reverse indirect hemagglutination test (RIHA) in self-dead small mammals. Animal serum from dogs, cats and mice were collected for detection of plague F1 antibody by indirect hemagglutination test (IHA). Results:A total of 1 019 host animals including self-dead small mammals were collected, belonging to 22 species, 12 genera, 6 families, 4 orders. Among them, 1 016 small mammals were captured by tools and 996 were outdoors, with the capture rate of 25.28% (996/3 940). The dominant species of small mammals outdoors were Apodemus chevrieri, Rattus (R.) rattus, Eothenomys miletus and Crocidura attenuate, which accounted for 30.32% (302/996), 22.09% (220/996), 17.37% (173/996) and 12.35% (123/996). The common species were Niviventer confucianus, R.nitidus and R.norvegicus, which accounted for 8.13% (81/996), 4.02% (40/996) and 1.81% (18/996). A total of 20 small mammals of 9 species were captured indoors in the residential area, and the capture rate was 1.11% (20/ 1 800). The dominant species were R.norvegicus, R.nitidus and Mus musculus, which accounted for 30.00% (6/20), 25.00% (5/20) and 10.00% (2/20). Eighteen small mammals of 8 species were infected with 67 parasitic fleas, belonging to 5 species, 5 genera, 3 families. The total flea infection rate was 1.77% (18/1 019) and the total flea index was 0.070. Among them, 49 parasitic fleas from 4 small mammals of 3 species were collected indoors. The flea infection rate was 19.05% (4/21) and the flea index was 2.333. Leptopsylla segnis had the highest flea infection rate of 9.52% (2/21) and flea index of 0.571. Ctenocephalides felis had the highest flea index of 1.571 and flea infection rate of 4.76% (1/21). They were the main flea species on the body surface of small mammals in residential areas. There were 14 small mammals infected with parasitic fleas outdoors, and 18 fleas in 5 species were collected with flea infection rate of 1.40% (14/998) and flea index of 0.018. Among them, Leptopsylla segnis had the highest flea infection rate was 0.50% (5/998) and the flea index was 0.005. The flea infection rate of Neopsylla specialis specialis was 0.40% (4/998), and the flea index was 0.004. Ctenophthalmus quadratus had the highest flea index of 0.007, and the flea infection rate ranked the third with 0.30% (3/998). The flea infection rate and flea index of Frontopsylla spadix spadix were the lowest, which were 0.20% (2/998) and 0.002, respectively. Ctenophthalmus quadratus, Leptopsylla segnis and Neopsylla specialis specialis were the dominant parasitic fleas on the surface of outdoor small mammals. A total of 419 indicator animal sera were collected, including 402 dog sera. One of them was positive by IHA, with a positive rate of 0.25% (1/402). Seventeen serum samples were collected from cats and mice, and IHA test results were negative. Yersinia pestis was isolated and cultured from the organs of small mammals and the detection of Yersinia pestis by colloidal gold test was negative. RIHA test of self-dead small mammals was negative. Conclusion:A plague indicator animal positive spot is newly found in the plague natural foci in Yulong County, and the plague epidemic monitoring, prevention and control in this region should be strengthened.
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Objective To investigate the relationship between the expression level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) and clinical prognosis of liver transplantation for hepatocellular carcinoma. Methods The clinical data of 94 recipients undergoing liver transplantation for hepatocellular carcinoma were retrospectively analyzed. The expression of 15-PGDH in the pathological tissues of all recipients was detected by immunohistochemical staining. The relationship between the expression level of 15-PGDH protein and clinical parameters of hepatocellular carcinoma patients was analyzed. The 5-year tumor-free survival and overall survival rates of liver transplant recipients were calculated. The possible independent risk factors of the clinical prognosis of liver transplant recipients were analyzed. Results The expression level of 15-PGDH was significantly correlated with age, Child-Pugh grade and preoperative level of alpha-fetoprotein (AFP) of the recipients (all P < 0.05). The tumor-free survival and overall survival rates of the recipients with low expression of 15-PGDH were significantly lower than those in their counterparts with high expression of 15-PGDH (both P < 0.05). The expression level of 15-PGDH, degree of tumor differentiation and American Joint Committee on Cancer (AJCC) staging were the independent risk factors of clinical prognosis of liver transplantation for hepatocellular carcinoma (all P < 0.05). Conclusions The expression level of 15-PGDH is an independent risk factor of clinical prognosis of liver transplantation for hepatocellular carcinoma.
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Objective To evaluate the role of poly( ADP-ribose) polymerase-1 ( PARP-1) in lung ischemia-reperfusion ( I/R ) injury in rats and the relationship with autophagy. Methods Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 200-240 g, were divided into 3 groups (n=8 each) using a random number table method: sham operation group (S group), lung I/R group ( I/R group) and lung I/R plus PARP-1 inhibitor PJ34 group ( I/R+PJ34 group) . The chest was only opened without clamping the left hilum of lung in group S. Lung I/R injury model was established by clam-ping the left hilum of lung for 45 min followed by 120 min reperfusion in I/R and I/R+PJ34 groups. PJ3410 mg/kg was intraperitoneally injected at 30 min before ischemia in group I/R+PJ34, while the equal volume of normal saline was injected in S and I/R groups. The rats were sacrificed at the end of reperfusion, and lungs were removed for microscopic examination of the pathological changes ( with a light microscope) which were scored and for determination of wet to dry weight ratio ( W/D ratio) , cell apoptosis ( by TUNEL) , ex-pression of PARP-1 activity markers ( PAR) , Bcl-2, Bax, microtubule-associated protein 1 light chain 3Ⅰ ( LC3-Ⅰ) , LC3-Ⅱ and Beclin-1 ( using Western blot ) . The apoptosis index, Bcl-2/Bax ratio and LC3-Ⅱ/LC3-Ⅰ ratio were calculated. Results Compared with S group, the W/D ratio, pathological scores, apoptosis index and LC3-Ⅱ/LC3-Ⅰ ratio were significantly increased, the expression of PAR and Beclin-1 was up-regulated, and Bcl-2/Bax ratio was decreased in I/R and I/R+PJ34 groups (P＜0. 05). Compared with I/R group, the W/D ratio, pathological scores, apoptosis index, and LC3-Ⅱ/LC3-Ⅰratio were significantly decreased, the expression of PAR and Beclin-1 was down-regulated, and Bcl-2/Bax ratio was increased in I/R+PJ34 group ( P＜0. 05) . Conclusion PARP-1 activation is involved in lung I/R inju-ry in rats, and the mechanism may be related to increasing autophagy and inducing cell apoptosis.
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OBJECTIVE@#To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.@*METHODS@#The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.@*RESULTS@#A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.@*CONCLUSIONS@#The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
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Adult , Aged , Female , Humans , Male , Middle Aged , Abdomen , General Surgery , China , Cross-Sectional Studies , General Surgery , Operative Time , Postoperative Complications , Preoperative Period , Retrospective Studies , Risk Factors , Surgical Wound InfectionABSTRACT
Objective To observe the effect of apatinib (APA) combined with radiotherapy on cell cycle and apoptosis of cervical cancer HeLa cells in vitro. Methods HeLa cells in logarithmic growth phase were divided into control group, drug group, radiotherapy group and joint group. Cell cycle and apoptosis were detected by flow cytometry, and the changes of HeLa cell cycle and apoptosis after radiotherapy were analyzed. Results Retardant of G0/G1 phase for joint group was obviously higher than control and radiotherapy group (P ＜ 0. 05). S phase percentage of joint group was minimum when compared with control group (P ＜0. 05), while there was no significant difference when compared with radiotherapy group. Apoptosis rate of joint group was higher than control group and drug group (P ＜ 0. 05 ). Conclusion APA combined with radiotherapy shows significant G0/G1 phase cell cycle arrest, but no significant induction of apoptosis.
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Objective@#To evaluate whether the self-designed single-channel intracavitary applicator yields equivalent clinical efficacy and safety to the standard Fletcher-type three-channel applicator in the high-dose-rate (HDR) brachytherapy for uterine cervical cancer.@*Methods@#From December 2011 to April 2017, patients initially diagnosed with cervical cancer were randomly assigned into the external beam radiotherapy (EBRT)+ single-channel intracavitary applicator group (the patent single-channel group) and EBRT+ the Fletcher applicator group. Whole pelvis irradiation was delivered with 6-MV photons via a four-field box variant or anterior and posterior parallel fields. Five to six fractions of intracavitary brachytherapy were performed at a dose of 7 Gy at point A once a week after 30 Gy (BED at point A: 80-90 Gy). Chemotherapy was given with intravenous injection of cisplatin at a dose of 40 mg/m2 once weekly during EBRT.Clinical efficacy and safety were evaluated after the treatment.@*Results@#In total, 150 eligible cases were assigned into the Fletcher applicator group and 149 cases into the patent single-channel group. The short-term clinical efficacy and acute toxicity did not significantly differ between two groups. The response rate was 94.0% in the Fletcher group, and 94.7% in the patent single-channel group. In the Fletcher applicator group, 76(50.7%) patients developed ≥ grade 3 hematologic toxicity and 61(40.9%) in the patent group (P=0.195).@*Conclusions@#The self-designed patent single-channel intracavitary applicator yields equivalent clinical efficacy and safety (acute toxicity) to the standard Fletcher-type three-channel applicator in the HDR brachytherapy for uterine cervical cancer.@*Clincal Trial Registration@#Chinese Clinical Trial Registry (ChiCTR-TRC-12002321).
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Objective@#To evaluate the anti- herpes simplex virus type 1 (HSV-1) activity of KPC-rg1, a water extract from Cinnamomum cassia, and explore its potential function of broad-spectrum antivirus effect.@*Methods@#In vitro, the changes of morphology of Vero cells were assessed and viral loads were detected after cells were infected with HSV-1 alone and HSV-1 pre-treated with KPC-rg1 respectively. The corneal lesions of mouse and tree shrew corneal infection model were evaluated after they were infected with HSV-1 alone and HSV-1 pre-treated with KPC-rg1 respectively. The antiviral activity of KPC-rg1 against 9 viruses were measured by CPE and GFP reduction assays.@*Results@#The virus replication of HSV-1 infected cells was moderately inhibited by KPC-rg1 in a dose range of 0.0001-1.0 mg/ml, while the cells were completely protected when they were infected with HSV-1 pre-treated with KPC-rg1 (0.001-1.0 mg/ml). The corneal lesions of animals were improved in both mouse and tree shrews models infected with HSV-1 after the treatment of KPC-rg1, while animals were completely protected from infection when HSV-1 pre-treated with KPC-rg1. KPC-rg1 had a potential anti-virus effect on the enveloped viruses such as HSV-1, HCMV, RSV alone and HIV-1.@*Conclusions@#KPC-rg1 is a collosol (Tyndall effect) which would immediately form a stable super-nanoparticle structure of KPC-rg1/virus when encounter virus, and thus the virus coated by KPC-rg1 lost its ability of infection. KPC-rg1 can reduce the suffering by newly or latent virus infection because its encapsulation of virus and inhibition of further infection. Our study added additional proofs of the anti-viral property of the water extract from Cinnamomum cassia, and provided a further basis to develop KPC-rg1 as a drug which could be potentially applied in clinic to treat HSV-1 infection.
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Aim To establish a novel acute hyperuricemia mouse model and apply it to evaluate the hyporucicemia effects of Ulodesine, a purine nucleoside phosphorylase(PNP) inhibitor.Methods The mice were intraperitoneal injected inosine and subcutaneous injected Oteracil potassium to induce accumulation of uric acid, and the animal blood was collected from eyeball or vena angularis in different time points.The levels of serum uric acid were measured and determined to test whether the acute hyperuricemia mouse model were successful or not.In order to verify the hyperuricemia seen in the model was associated with the accumulation of inosine, which was converted to uric acid by action of PNP,hyporucicemia effects of Ulodesine, a PNP inhibitor, was assessed in an enzyme assay and confirmed by using the newly established model.Result Accumulation of uric acid in the blood of mouse models was observed by combined injections of intraperitoneal 200 mg·kg-1 inosine and subcutaneous 200 mg·kg-1 Oteracil potassium respectively after 1.5 h.The enzyme assay indicated that Ulodesine was a potently PNP inhibitor with IC50 of 2.293 nmol·L-1.IV injection of Ulodesine eliminated uric acid accumulations in blood of the mouse model, which was expected as the in vivo action of Ulodesine.Conclusions A novel acute hyperuricemia mouse model is established.This is a relatively easy and more effective protocol to generate the hyperuricemia in mice, which will be a useful platform to assess the anti-hyperuricemia activity of PNP-target drugs in vivo.
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Objective To study the predicting value of four different scoring systems such as the acute physiology and chronichealth evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score and systemic inflammatory response syndrome (SIRS) score for the prognosis of septic patients. Methods A retrospective analysis were conducted. Septic patients in intensive care unit (ICU) of the First People's Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled.Patients were divided into survival group and death group according to 28-day outcome. The difference of clinic data, the worst clinical index value within 24 hours, whether mechanical ventilation performed on first day, length of stay in ICU, APACHE Ⅱ score, SOFA score, qSOFA score and SIRS score were compared between the two groups. The significant different factors of sepsis outcome in univariate analysis were analyzed by multiple logistic regression, and the ability of four scoring systems was tested by receiver operating characteristic (ROC) curve.Results 311 patients were enrolled in this study (221 survivals, 90 deaths, 28-day mortality rate 28.9%). Univariate analysis showed age, mechanical ventilation ratio, urine output, length of stay in ICU and the fastest heart beat rate (HR), the lowest systolic blood pressure (SBP), the lowest mean arterial pressure (MAP), HCO3-, minimum arterial blood oxygen partial pressure (PaO2), minimum oxygenation index (PaO2/FiO2), the maximum fraction of inspired oxygen (FiO2), Na+, the highest concentration of blood urea nitrogen (BUN), the highest concentration of serum creatinine (SCr), minimum concentration of plasma albumin (Alb), Glasgow coma score (GCS) score, APACHE Ⅱ score, SOFA score, qSOFA score, within 24 hours after diagnosis were significantly different between two groups (allP < 0.05). Multiple logistic regression showed age [odds ratio (OR) = 1.388, 95% confidence interval (95%CI) = 1.074-1.794,P = 0.012], PaO2/FiO2 (OR = 0.459, 95%CI = 0.259-0.812,P = 0.007), concentration of plasma Alb (OR = 0.523, 95%CI = 0.303-0.903,P = 0.020), GCS score (OR = 0.541, 95%CI = 0.303-0.967,P = 0.038) and SOFA scores (OR = 3.189, 95%CI = 1.813-5.610,P = 0.000) were independent risk factors for sepsis outcome. ROC curve test showed the APACHE Ⅱ score, SOFA score and qSOFA score had the ability to predict the outcome in critical ill patients with sepsis, the SOFA score of the most powerful, the area under the ROC curve (AUC) was 0.700,when the cut-off value was 7.5 points, the sensitivity was 73.3% and specificity was 58.8%.Conclusions APACHE Ⅱ score, SOFA score and qSOFA score have the predictive properties for septic patients. SOFA score is an independent prognostic risk factor of sepsis, while qSOFA score can be widely used in clinical practice as the advantage of quick evaluating.
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Objective:To analyze the content of Pb, Cd, Cu, As and Hg in freeze-dried Rehmannia from different habitats by FAAS and double channels AFS. Methods:The contents of Pb,Cd and Cu in Rehmannia from different habitats were directly deter-mined by FAAS, while the contents of As and Hg were determined by double channels AFS after pretreated with HNO3-HClO4 . Re-sults:It was shown that each element had good linear relationship with the correlation coefficient above 0. 997 4. The average recovery was 97. 88%-100. 90% with RSD of 0. 019% -4. 20% (n=6). Meanwhile, the concentrations of 5 harmful elements and heavy met-als in 4 batches of 10 samples were higher than the limits described in Chinese pharmacopoeia. Conclusion:The results measured by the method are considered to be accurate, quick and easy to be operated. It can be used to determine heavy metals and harmful ele-ments in freeze-dried Rehmannia from different habitats.
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Objective To investigate the clinical efficacy for different treatments of stage Ⅳ right colorectal cancer and its prognostic factors.Methods The clinical data of 106 patients with stage Ⅳ right colorectal cancer who were admitted to the First People's Hospital of Chenzhou from January 2008 to December 2013 were retrospectively analyzed.Among the 106 patients,42 patients receiving palliative resection were allocated to the palliative resection group,30 patients receiving colostomy were allocated to the colostomy group,20 patients receiving bypass surgery were allocated to the bypass group and 14 patients without treatment were allocated to the non-treatment group.Fluorouracil + leucovorin (5-FU/LV) were used as postoperative chemotherapeutics,and the time of chemotherapy was 2 to 6 months.The follow-up was applied to the patients by outpatient examination and telephone interview till February 2014.The non-normal distribution data were described as median and range.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.The continuous variables were cut into the categorical variables.The univariate analysis of categorical variables was done using chi-square test,and the multivariate analysis was done using the COX regression model.Results The incidences of postoperative complications in the palliative resection group,in the colostomy group and in the bypass group were 47.6％ (20/42),40.0％ (12/30) and 65.0％ (13/20),respectively,with no significant difference (x2=3.053,P ＞ 0.05).One-hundred patients were followed up for 14.0 months (range,3.0-40.0 months),with overall median survival time of 10.3 months (range,2.6-27.0 months) and the 1-,2-year survival rates of 36.8％ and 6.7％.The median survival time and 1-,2-year survival rates were 11.5 months (range,4.3-27.0 months),47.6％,16.7％ in the palliative resection group,8.5 months (range,3.5-18.0 months),20.0％,0 in the colostomy group,9.0 months (range,3.0-13.0 months),15.0％,0 in the bypass surgery and 5.0 months (range,2.6-10.0 months),0,0 in the non-treatment group,showing a significant difference in the prognosis of patients among the 4 groups (x2 =42.395,P ＜ 0.05).The prognosis of patients in the palliative resection group were significantly different from those in the other 3 groups (x2 =5.786,6.178,10.378,P ＜0.05),there was no significant difference in the prognosis of patients between the colostomy group and the bypass surgery group (x2 =0.203,P ＞ 0.05).The results of univariate analysis showed that T stage,N stage,tumor differentiation,preoperative obstruction,peritoneal implantation,methods of treatment,chemotherapy and postoperative complications were related factors affecting the prognosis of patients with stage Ⅳ right colorectal cancer (x2=37.428,48.586,32.550,22.739,33.562,42.395,21.517,11.530,P＜0.05).T4 stage,N2 stage,poor-differentiated tumors and peritoneal implantation were independent risk factors affecting the poor prognosis of patients with stage Ⅳ right colorectal cancer (RR =2.336,2.945,2.182,3.500,95％ confidence interval:1.102-4.953,1.156-7.501,1.003-4.749,1.573-7.787,P ＜0.05).The postoperative chemotherapy was an independent factor affecting the good prognosis of patients with stage Ⅳ right colorectal cancer (RR =0.495,95％ confidence interval:0.271-0.904,P ＜ 0.05).Conclusion Palliative resection can improve the prognosis of patients with stage Ⅳ right colorectal cancer.T4 stage,N2 stage,poor-differentiated tumor,and peritoneal implantation were independent risk factors affecting the poor prognosis of patients with stage Ⅳ right colorectal cancer,while postoperative chemotherapy was an independent factor affecting the good prognosis of patients with stage Ⅳ right colorectal cancer.
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Objective To explore the clinical effect and safety of high frequency oscillatory ventilation (HFOV) combined thoracic close drainage for the treatment of mechanical ventilated neonates with pneumothorax.Methods Twenty-two neonates were enrolled in this study,who needed mechanical ventilation diagnosed with neonatal pneumothorax and received treatment of HFOV combined thoracic close drainage from Jan.2012 and Jun.2014 in the People's Hospital of Dongguan.We recorded blood gas analysis and parameters of breathing machine before using HFOV and 2,12,24,48 hours after using HFOV respectively.Results There were significant differences between HFOV before use (0) and 2,12,24,48 hours after using HFOV in terms of blood pH value,arterial partial pressure of oxygen(PaO2),partial pressure of arterial carbon dioxide (PaCO2),oxygenation index (OI),the inspired oxygen concentration (FiO2),mean airway pressure (MAP) (F =6.606,17.760,8.387,17.242,25.185; P ＜ 0.05).Compared with before using HFOV combined thoracic close drainage,PaO2 was significantly increased from (51.25 ± 13.16) mmHg to (62.60 ± 15.95) mmHg.PaCO2 was significantly dropped from (63.57 ± 13.81) mmHg to (54.02 ± 11.58) mmHg and OI was dropped sharply from (16.57 ± 9.09) to (11.28 ± 4.67) at 2 hours after using HFOV combined thoracic close drainage (P ＜ 0.05).FiO2 significantly decreased from (0.76 ± 0.15) to (0.60 ± 0.13),as well as MAP from (9.91 ± 1.44) cm H2 Oto (8.50 ± 1.68) cm H2O.Furthermore,pH was significantly improved from (7.24 ± 0.15) to (7.34 ±0.10) at 12 hours later(P ＜0.05).PH,PaO2,PaCO2 were roughly back to normal at 48 hours after treatment.The main complications were intraventricular hemorrhage (2 cases),subarachnoid hemorrhage (2 cases),ventilator associated pneumonia (1 case) and pulmonary hemorrhage (1 case) (not during the time of HFOV treatment).Conclusion HFOV combined thoracic close drainage for the treatment of neonates with pneumothorax is safety and effective methods.
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Objective To explore the relationship between inflammatory cytokine expression and outcome of acute stroke.Methods Eighty six acute stroke patients and 80 health people were recruited as the case and control group respectively.Peripheral blood CD3 +, CD4 +, CD8 +T cells were analyzed with flow cytometry;IL-10, IL-6, IFN-γin peripheral blood and cerebrospinal fluid ( CSF) were detected with enzyme linked immunosorbent assay ( ELISA); Outcome of acute stroke patients were evaluated with Na-tional Institutes of Health Stroke Scale(NIHSS)scoring in the 5th day.Results Contrast with the controls, the expression of CD3 +, CD4 +and CD8 +in case group were decresed( P <0.01), IFN-γexpression in peripheral blood of cases (within the 24th hour) were lower( P <0.01).IL-10 expression were higher( P=0.001).IL-10 was down-regulation of expression( P <0.01)at the 5th day compared with the 24th hours in peripheral blood, but up-regulation in CFS( P <0.01), and IFN-γwas down-regulation of expression ( P <0.01) at the 5th day.Conclusions IL-10 and IFN-γexpression changes lead to disorder of immune balance and are harmful for progressive acute stroke patients, Monitoring the change of IL-10,IL-6 and IFN-γare helpful for diagnosis and prognosis of acute stroke.
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Objective To evaluate the application value of the rabbit for training the basic skills of urologic laparoscopic surgery . Methods The rabbit models of laparoscopic nephrectomy ,ureteral anastomosis and pyeloureteroplasty were established ;in the self-made simulation training box ,8 clinical doctors without the actual operating experience of laparoscopic surgery participated in 10 rounds of simulation training by taking the 3 operation models .The operation completion time for each time was recorded .The learning curves and the training effects were observed .Results 8 doctors were successfully completed training .The operative time of laparoscopic nephrectomy was declined from (45 .75 ± 6 .88)min at the first time to (30 .75 ± 4 .53)min at the sixth time and (25 .86 ± 3 .31)min at the final time ;the operative time of laparoscopic ureteral anastomosis from (56 .75 ± 7 .13)min at the first time to(43 .00 ± 4 .34)min at the eighth time and(35 .50 ± 4 .04)min at the final time ;the operative time of laparoscopic pyeloureteroplas-tyfrom(77.38±5.34)minatthefirsttimeto(59.13±7.26)minatthefinaltime;thedifferenceswerestatisticallysignificant(P<0 .05) .Furthermore ,the probability of repeated sewing and tearing tissue were significantly decreased on the whole .The controlled stitch length and edge length also were more accurate .The quality and appearance of the complete operation were significantly im-proved .Conclusion Rabbit can be conveniently used to set up the animal models for training laparoscopic nephrectomy ,ureteral an-astomosis and pyeloureteroplasty ,which is suitable for clinical urologic doctors to train the basic operating skills of laparoscopic sur-gery .
ABSTRACT
<p><b>BACKGROUND</b>Melanoma has the highest mortality among all superficial malignant tumors. The poor prognosis is due to its high metastasis rate and the lack of therapeutic targets. As a molecular switch that controls tumor metastasis, Ras homology C (RhoC) has been correlated with tumor progression, especially tumor invasion and metastasis. However, little research has been done about the effects of RNA interference (RNAi) targeting RhoC on the invasion and metastasis of melanoma. In this study, we constructed an RNAi lentivirus vector targeting the RhoC gene of melanoma cells and identified its silencing effects on the RhoC gene.</p><p><b>METHODS</b>Based on the RhoC gene encoding information, three pGPU6/GFP/Neo-short hairpin (shRNA) plasmids were constructed. After detecting their silencing effects on the RhoC gene of A375 cells, the most effective pGPU6/GFP/Neo-shRNA plasmid was packed with lentivirus to construct the recombinant pLenti6.3-EGFP-453 targeting RhoC. The lentivirus vector was used to infect A375 cells, and then the expression of RhoC mRNA and protein were determined with real-time PCR and Western blotting.</p><p><b>RESULTS</b>The plasmids pGPU6/GFP/Neo-shRNA 336, pGPU6/GFP/Neo-shRNA 453, and pGPU6/GFP/Neo-shRNA 680 were constructed. After they were transfected into A375 cells, the expressions of RhoC mRNA and protein were 1.47 ± 0.26, 1.13 ± 0.16, 1.39 ± 0.11 and 70.98 ± 9.21, 50.67 ± 6.06, 65.77 ± 4.06, respectively. pGPU6/GFP/Neo-shRNA 453 was the most effective sequence, and was used to successfully construct the pLenti6.3-EGFP-453 lentiviral vector targeting RhoC. pLenti6.3-EGFP-453 was used to infect A375 cells. The expression of RhoC mRNA and protein were 1.05 ± 0.05 and 62.04 ± 15.86 in the lentivirus group, 4.21 ± 0.24 and 220.86 ± 24.07 in the negative lentivirus control group, and 4.63 ± 0.32 and 257.39 ± 12.30 in the normal control group respectively with the difference between the lentivirus group and the control groups being statistically significant (P < 0.05).</p><p><b>CONCLUSION</b>The successfully constructed pLenti6.3-EGFP-453 vector targeting the RhoC can effectively infect human melanoma A375 cells in vitro, and significantly inhibit the RhoC mRNA and protein expression.</p>
Subject(s)
Humans , Cell Line, Tumor , Genetic Vectors , Genetics , Lentivirus , Genetics , Melanoma , Genetics , Therapeutics , RNA Interference , Physiology , rho GTP-Binding Proteins , Genetics , Metabolism , rhoC GTP-Binding ProteinABSTRACT
<p><b>OBJECTIVE</b>To introduce a training model for laparoscopic dismembered pyeloplasty.</p><p><b>METHODS</b>The model of ureteropelvic junction obstruction was simulated using pig kidney and chicken crop. With the model placed in a training box, 8 residents without laparoscopic experience but with basic technical training performed 10 rounds of anastomosis according to the standard operation procedures. For each resident, the operating time and quality of the operation were recorded and assessed.</p><p><b>RESULTS</b>All the 8 residents successfully completed the training. The operating time decreased from 72.70∓8.26 min in the first training session to 54.50∓7.69 min in the last training session, and the anastomosis error score decreased from 5.60∓1.35 to 2.50∓1.58 min, showing significant differences between the recordings (P<0.05).</p><p><b>CONCLUSION</b>This simple training model allows effective simulation of the surgical procedures of laparoscopic pyeloplasty and is suitable for training surgeons without laparoscopic experiences.</p>
Subject(s)
Animals , Chickens , Crop, Avian , General Surgery , Kidney Pelvis , General Surgery , Laparoscopy , Methods , Models, Animal , Plastic Surgery Procedures , Education , Suture Techniques , Education , Urologic Surgical Procedures , EducationABSTRACT
Objective To investigate the effects of morphine and tramadol pre-emptive use on the expressions of substance P mRNA (SPmRNA) and calcitonin gene-related peptide mRNA (CGRPmRNA) in dorsal root ganglia (DRG) following acute myocardial ischemia in the rats. Method Twenty-four adult male SD rats weighing 270 to 300 g were randomly (random number) divided into four groups (n = 6, in each): group Ⅰ(sham operation), group Ⅱ (myocardial ischemia), group Ⅲ (morphine pre-emptive use) and group Ⅳ (tramadol pre-emptive use). The left anterior descending branch of coronary artery was occluded (CAO) for 3 hours in rats of group Ⅱ and Ⅳ.In group Ⅲ morphine 1.25 mg·kg-1 was injected through caudal vein 15 minutes before CAO.In group Ⅳ,tramadol 12.5 mg·kg-1 was daministered via caudal vein 15 minutes before CAO.In 3 hours after myocardial ischemia, the tissue of DRG (T1-5) were taken for detecting the expressions of SPmRNA and CGRPmRNA by using RT-PCR. One-way ANOVA was used for statistical analysis. Results In the tissue of DRG, the expressions of SPmRNA(0.93±0.02) ,α-CGRP mRNA(0.98±0.02) and β-CGRP mRNA(0.83 ± 0.02)were up-regulated in group Ⅱ compared with those in group Ⅰ (0.84±0.04),(0.86±0.01),(0.45±0.03) (P ＜0.05),and decreased markedly in group Ⅲ (0.88 ± 0.03) ,(0.90 ± 0.02), (0.67 ± 0.02) (P ＜ 0.05) and group Ⅳ (0.88±0.04) ,(0.90 ± 0.01),(0.66±0.01) (P ＜ 0.05), but showed no difference between group Ⅲ and Ⅳ (P ＞ 0.05). Conclusions Morphine and tramadol pre-emptive use can significantly inhibit the expressions of SPmRNA and CGRPmRNA in rat's dorsal root ganglia after CAO.