Clinicopathological features and prognosis of anorectal melanoma: A report of 68 cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinicopathological characteristics of anorectal mucosal melanoma (ARMM), and to evaluate the prognostic factors.@*METHODS@#A total of 68 primary ARMM surgical specimens from 2010 to 2018 were retrospectively studied. Slides were reviewed to evaluate pathological features. Slingluff staging method was used for staging.@*RESULTS@#(1) Clinical features: The median age at diagnosis in this group was 61.5 years, with a male-to-female ratio 1 ∶1.62. The most common complaint was blooding (49 cases). For anatomic site, anorectum was the prevalent (66.2%), followed by rectum (20.6%). At the time of diagnosis, 28 cases were stage Ⅰ (localized stage, 41.2%), 25 cases were stage Ⅱ (regional lymph node metastasis, 36.8%), and 15 cases were stage Ⅲ (distant metastasis, 22.1%). Five patients underwent wide local excision, the rest abdominoperineal resection, and 48 patients received adjuvant therapy after surgery. (2) Pathological features: Grossly 88.2% of the tumors were exophytic polypoid masses, with the median tumor size 3.5 cm and the median tumor thickness 1.25 cm. Depth of invasion below lamina muscularis mucosae ranged from 0-5.00 cm (median 1.00 cm). The deepest site of tumor invasion reached muscular layer in 27 cases, and perirectal tissue in 16 cases. Melanin pigmentation was absent or not obvious in 67.6% of the cases. The predominant cytology was epithelioid (45 cases, 66.2%). The rate for ulceration, necrosis, lymphovascular invasion, and perineural invasion was 89.7%, 35.3%, 55.9%, and 30.9%, respectively. The median mitotic count was 18/mm2. The positive rate of S100, HMB-45 and Melan-A were 92.0%, 92.6% and 98.0%, respectively. The median of Ki-67 was 50%. The incidences of mutations within CKIT, BRAF and NRAS genes were 17.0% (9 cases), 3.8% (2 cases) and 9.4% (5 cases), respectively. (3) Prognosis: Survival data were available in 66 patients, with a median follow-up of 17 months and a median survival time of 17.4 months. The 1-year, 2-year and 5-year overall survival rate was 76.8%, 36.8% and 17.2%, respectively. The rate of lymphatic metastasis at diagnosis was 56.3%. Forty-nine patients (84.5%) suffered from distant metastasis, and the most frequent metastatic site was liver. Univariate analysis revealed that tumor size (>3.5 cm), depth of invasion below lamina muscularis mucosae (>1.0 cm), necrosis, lymphovascular invasion, BRAF gene mutation, lack of adjuvant therapy after surgery, deep site of tumor invasion, and high stage at diagnosis were all poor prognostic factors for overall survival. Multivariate model showed that lymphovascular invasion and BRAF gene mutation were independent risk factors for lower overall survival, and high stage at diagnosis showed borderline negative correlation with overall survival.@*CONCLUSION@#The overall prognosis of ARMM is poor, and lymphovascular invasion and BRAF gene mutation are independent factors of poor prognosis. Slingluff staging suggests prognosis effectively, and detailed assessment of pathological features, clear staging and genetic testing should be carried out when possible. Depth of invasion below lamina muscularis mucosae of the tumor might be a better prognostic indicator than tumor thickness.

Comparison of curative effect between percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients / 中国骨伤

OBJECTIVE@#To compare the efficacy of percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients.@*METHODS@#From January 2015 to July 2020, 68 young and middle-aged patients with displaced femoral neck fracture were retrospectively analyzed. Among them, 31 cases were fixed by percutaneous compression plate (PCCP), and 37 cases were fixed by cannulated compression screw (CCS). General data such as gender, age, cause of injury, comorbidities, fracture classification and cause of injury of two groups were collected. The operation time, intraoperative blood loss, hospital stay, full weight bearing time, fracture healing time, visual analogue scale(VAS), Harris hip score and complications were compared between two groups.@*RESULTS@#Patients in both groups were followed up for more than 2 years. There were no significant differences in operation time, intraoperative blood loss, fracture reduction quality, hospital stay and VAS between two groups. The fracture healing time in PCCP group was significantly shorter than that in CCS group (t=-4.404, P=0.000). The complete weight bearing time of PCCP group was significantly shorter than that of CCS group (t=-9.011, P=0.000). Harris score of hip joint in PCCP group was better than that in CCS group 2 years after operation (P=0.002). Complications occurred in 3 cases (9.68%) in PCCP group, while 11 cases (29.72%) in CCS group, with a statistically significant difference (P=0.042).@*CONCLUSION@#Both PCCP and CCS can be used for the treatment of displaced femoral neck fractures in young and middle-aged people. Compared with CCS, PCCP fixation can achieve shorter fracture healing time and create conditions for early full weight bearing. PCCP results in higher hip score and lower complications.

Sex differences in clinical outcomes of extremely preterm infants/extremely low birth weight infants: a propensity score matching study / 中国当代儿科杂志

OBJECTIVES@#To study the effect of sex on the clinical outcome of extremely preterm infants (EPIs)/extremely low birth weight infants (ELBWIs) by propensity score matching.@*METHODS@#A retrospective analysis was performed for the medical data of 731 EPIs or ELBWIs who were admitted from January 1, 2011 to December 31, 2020. These infants were divided into two groups: male and female. A propensity score matching analysis was performed at a ratio of 1:1. The matching variables included gestational age, birth weight, percentage of withdrawal from active treatment, percentage of small-for-gestational-age infant, percentage of use of pulmonary surfactant, percentage of 1-minute Apgar score ≤3, percentage of mechanical ventilation, duration of mechanical ventilation, percentage of antenatal use of inadequate glucocorticoids, and percentage of hypertensive disorders in pregnancy. The two groups were compared in the incidence rate of main complications during hospitalization and the rate of survival at discharge.@*RESULTS@#Before matching, compared with the female group, the male group had significantly higher incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and patent ductus arteriosus (P<0.05), while after matching, the male group only had a significantly higher incidence rate of BPD than the female group (P<0.05). There was no significant difference in the rate of survival at discharge between the two groups before and after matching (P>0.05).@*CONCLUSIONS@#Male EPIs/ELBWIs have a higher risk of BPD than female EPIs/ELBWIs, but male and female EPIs/ELBWIs tend to have similar outcomes.

Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study / 中国当代儿科杂志

OBJECTIVES@#To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China.@*METHODS@#A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined.@*RESULTS@#The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05).@*CONCLUSIONS@#It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Effect of weight growth velocity in the early stage after birth on neurodevelopment of preterm infants at the corrected age of 12 months / 中国当代儿科杂志

OBJECTIVE@#To study the effect of weight growth velocity in the early stage after birth on the neurodevelopment of preterm infants at the corrected age of 12 months.@*METHODS@#Related data were collected from the preterm infants who were discharged from the Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University, from July 1, 2015 to December 31, 2019 and were followed up at the outpatient service of high-risk infants. According to the weight growth velocity from birth to the corrected gestational age of 40 weeks, the infants were divided into two groups: low velocity [< 10 g/(kg·d); @*RESULTS@#At the corrected age of 12 months, the low velocity group had a significantly lower score of fine motor (@*CONCLUSIONS@#The weight growth velocity from birth to the corrected age of 40 weeks affects the development of fine motor and language in preterm infants at the corrected age of 12 months; however it needs to be further verified by large-sample studies.

Analysis of perioperative factors and nursing countermeasures of intraoperative pressure sore after liver transplantation patients / 中国实用护理杂志

Objective:To study the related factors of pressure ulcer in liver transplantation patients, to understand the occurrence of postoperative pressure sores in liver transplantation patients, and to propose corresponding nursing strategies to provide theoretical basis for clinical nursing work.Methods:A total of 93 patients with liver transplantation were investigated for postoperative pressure ulcers using a general data sheet and a Braden risk assessment form.Results:The Braden risk score of liver transplantation patients was significantly positively correlated with pressure ulcers ( t value was -3.512, P<0.01). Among the risk factors affecting patients with surgical pressure sores, low pressure ulcer score, postoperative hypotension and low serum albumin were pressure ulcers. The risk factors, OR value were 1.185 (1.037-1.354), 9.443 (2.273-39.237), 1.325 (1.119-1.570), and the short operation time was the protective factor of pressure ulcer. The OR value was 0.729 (0.542-0.981). Conclusions:Clinical medical staff should take comprehensive measures to treat patients with liver transplantation in different situations, reduce the incidence of pressure ulcers and improve the quality of life of patients.

Epidemiological and clinical characteristics of acute upper respiratory infection of patients in peace-keeping operations area in Mali from 2014 to 2017 / 中华疾病控制杂志

Objective To analyze the epidemiological and clinical characteristics of acute upper respiratory infection of patients in peace-keeping operations area in Mali, so as to provide experiences for prevention and control of acute upper respiratory infection. Methods A retrospective analysis was made on the case history of upper respiratory tract infection from January 2014 to December 2017. The clinical data of the patients were recorded and the collected data were analyzed by descriptive epidemiological method. Results A total of 484 patients met the inclusion criteria. According to the time distribution, most patients with upper respiratory tract infections were concentrated in May, August, September and December. WBC in fever group were higher than those in normal temperature group (t=3.41, P=0.008), Gran in fever group were higher than those in normal temperature group (t=3.92, P0.05). The electrolyte K, Ca, Na and Cl values in fever group were lower than those in normal temperature group (all P<0.05). Conclusions In terms of time distribution, under the circumstances of rotation and handover of peacekeeping forces, seasonal change, large temperature difference between day and night, etc, the peacekeeping forces should take precautions to reduce the incidence of upper respiratory tract infections and avoid non-combat attrition of peacekeepers. From the analysis of clinical characteristics of upper respiratory tract infection, fever alone is not an indication of antibiotic use, but must be combined with symptoms, signs and laboratory examinations of patients. At the same time, patients with fever are prone to electrolyte disorders, which should be paid great attention by medical staff.

Quality Evaluation of Standard Decoction of Wine-processing Salviae Miltiorrhizae Radix et Rhizoma / 中国实验方剂学杂志

Objective:To establish the quality control method of the wine-processing Salviae Miltiorrhizae Radix et Rhizoma standard decoction,in order to provide reference for the quality evaluation of the wine-processing Salviae Miltiorrhizae Radix et Rhizoma formula granules and other related products. Method:Totally 15 batches of representative wine-processing Salviae Miltiorrhizae Radix et Rhizoma pieces were collected to prepare the standard decoction, establish the HPLC fingerprint and determine the content of five components(sodium danshensu,caffeic acid,rosmarinic acid,lithospermic acid,salvianolic acid B). The main common peaks in fingerprint were identified to define the main chemical constituents in the standard decoction, the parameters,such as dry extract rate,transfer rate of index components and pH of the standard decoction were calculated, and the comprehensive evaluation index was established to evaluate the stability of the preparation process. Result:The main component standard decoction was phenolic acids. The concentrations of five components(sodium danshensu,caffeic acid,rosmarinic acid,lithospermic acid,salvianolic acid B)in the standard decoction were 0.21%-0.37%,0.03%-0.10%,0.08%-0.18%,0.07%-0.13%,2.68%-4.34%, the dry extract rates of standard decoction were 71.8%-85.4%,50.0%-71.4%,68.2%-81.0%,66.7%-84.6%,67.5%-79.6%,the transfer rates were between 45.1%-55.3%,and pH value was between 5.91-6.05. The fingerprint similarities of the 15 batches of standard decoction with reference fingerprints were>0.98,the fingerprint showed 12 common peaks,7 of which were considered to be sodium danshensu,protocatechuic aldehyde,caffeic acid,ferulic acid,rosmarinic acid,lithosperic acid and salvianolic acid B. Conclusion:The established systematic evaluation for the quality of wine-processing Salviae Miltiorrhizae Radix et Rhizoma standard decoction is stable and feasible,and provides a reference for the quality control of relevant preparations of wine-processing Salviae Miltiorrhizae Radix et Rhizoma decoction.

Efficacy of 308-nm excimer laser versus high-intensity ultraviolet radiation for the treatment of active localized vitiligo / 中华皮肤科杂志

Objective To investigate the efficacy and safety of 308-nm excimer laser compared to high-intensity ultraviolet radiation for the treatment of active localized vitiligo,and to observe changes in skin lesions before and after the treatment by confocal laser scanning microscopy.Methods Sixty patients with 203 skin lesions of active localized vitiligo and were enrolled into this study,and the vitiligo disease activity (VIDA) score of these patients ranged from 2 to 3.We selected more than 3 skin lesions from a same anatomical site of each patient,one of lesions served as a control and the other skin lesions (≥ 2) were randomly treated with 308-nm excimer laser (laser group) or high-intensity ultraviolet radiation (ultraviolet group).The treatment was conducted twice a week for 25 sessions,and a 3-month follow-up was performed.Results A total of 48 patients with 169 skin lesions completed the trial.The marked response rate was significantly higher in the laser group [66.15％ (43/65)] than in the ultraviolet group [44.64％ (25/56),x2 =8.28,P ＜ 0.01].The patients with a VIDA score of 2 showed a significantly higher marked response rate [67.69％(44/65)] compared with those with a VIDA score of 3 [44.64％(25/56),x2 =6.80,P ＜ 0.01].During the 3-month follow-up,no relapse was observed.Confocal laser scanning microscopy showed that the number of inflammatory cells increased at the dermal-epidermal junction of the intra-and extra-marginal lesional skin.After treatment,the number of inflammatory cells markedly decreased and returned to normal level in lesions.Conclusion Both 308-nm excimer laser and high-intensity ultraviolet radiation are effective in the treatment of active localized vitiligo,but the 308-nm excimer laser shows a more rapid onset of action and a better therapeutic effect.

Application of Quality Risk Management in Drug Withdrawal Links of Hospital Pharmacy / 中国药房

OBJECTIVE:To control the drug quality risk in drug withdrawal links of hospital pharmacy,and provide reference for the application of quality risk management(QRM)in hospital pharmacy. METHODS:Drug QRM was developed in drug with-drawal links through risk identification,risk assessment,risk control,risk assessment and other steps. Using the incidence of risk factors and reusable rate of withdrawal drug as indexes,related data of before(Jul.-Dec. 2015)and after(Jan.-Jun. 2016)devel-oping QRM in our hospital were compared to evaluate the effect of drug QRM. RESULTS:Determining whether specific storage drugs kept the required storage conditions,whether the numbers of withdrawal drugs counted to minimal packaging and other 5 fac-tors were high-risk factors(the risk score of each factor>4 points);control measures were taken separately for high risk factors, then high-risk factors were reduced to acceptable levels(risk score<4 points). After developing QRM,the incidence of risk factors were reduced than before(reduce 1.35%-6.19%),reusable rate of withdrawal drug was increased(98.64% vs. 86.32%)(all P<0.05). CONCLUSIONS:Developing QRM in drug withdrawal links of hospital pharmacy can reduce the drug quality risk.

Surgical management of renal neoplasm extending into the inferior veno cava / 中华泌尿外科杂志

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

Rhubarb Monomers Protect Intestinal Mucosal Barrier in Sepsis via Junction Proteins / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Leakage of the intestinal mucosal barrier may cause translocation of bacteria, then leading to multiorgan failure. This study hypothesized that rhubarb monomers might protect the gut mucosal barrier in sepsis through junction proteins.</p><p><b>METHODS</b>Healthy male Sprague-Dawley rats (weighing 230-250 g) under anesthesia and sedation were subjected to cecal ligation and perforation (CLP). After surgical preparation, rats were randomly assigned to eight groups (n = 6 or 8 each group): sham group (Group A: normal saline gavage); sepsis group (Group B: normal saline gavage); Group C (intraperitoneally, dexamethasone 0.5 mg/kg) immediately after CLP surgery; and rhubarb monomer (100 mg/kg in normal saline)-treated groups (Group D: rhein; Group E: emodin; Group F: 3,8-dihydroxy-1-methyl-anthraquinone-2-carboxylic acid; Group G: 1-O-caffeoyl-2-(4-hydroxy-O-cinnamoyl)-D-glucose; and Group H: daucosterol linoleate). Animals were sacrificed after 24 h. Intestinal histology, lactulose, mannitol concentrations were measured, and zonula occludens (ZO)-1, occludin and claudin-5 transcription (polymerase chain reaction), translation (by Western blot analysis), and expression (by immunohistochemistry) were also measured.</p><p><b>RESULTS</b>Intestinal histology revealed injury to intestinal mucosal villi induced by sepsis in Group B, compared with Group A. Compared with Group A (0.17 ± 0.41), the pathological scores in Groups B (2.83 ± 0.41, P < 0.001), C (1.83 ± 0.41, P < 0.001), D (2.00 ± 0.63, P < 0.001), E (1.83 ± 0.41, P < 0.001), F (1.83 ± 0.75, P < 0.001), G (2.17 ± 0.41, P < 0.001),and H (1.83 ± 0.41, P < 0.001) were significantly increased. Lactulose/mannitol (L/M) ratio in Group B (0.046 ± 0.003) was significantly higher than in Group A (0.013 ± 0.001, P< 0.001) while L/M ratios in Groups C (0.028 ± 0.002, P< 0.001), D (0.029 ± 0.003, P< 0.001), E (0.026 ± 0.003, P< 0.001), F (0.027 ± 0.003, P< 0.001), G (0.030 ± 0.005, P< 0.001), and H (0.026 ± 0.002, P< 0.001) were significantly lower than that in Group B. ZO-1, occludin and claudin-5 transcription, translation, and expression in Group B were significantly lower than that in Group A (P < 0.001), but they were significantly higher in Groups C, D, E, F, G, and H than those in Group B (P < 0.05).</p><p><b>CONCLUSION</b>Rhubarb monomer treatment ameliorated mucosal damage in sepsis via enhanced transcription, translation, and expression of junction proteins.</p>

Occupational Carbon Monoxide Poisoning Associated with Diesel Motor Operation in an Air-raid Shelter in June 2015, Jinan City, China-An Epidemiological Investigation / 生物医学与环境科学（英文）

Occupational carbon monoxide (CO) poisoning related to diesel motor fumes in an air-raid shelter (ARS) was first identified in Jinan City, China, in June 2015. A total of 17 cases were identified, including 14 possible cases of firemen and 3 confirmed cases of water channel clean-up workers. The overall attack rate (AR) of firemen was 42% (14/33). The firemen had a significantly higher AR with a longer exposure and more protracted time of rescue in the ARS (P < 0.05). All the cases stated that they did not realize the potentially high level of exposure to CO in the ARS. CO poisoning posed a risk to both patients and service providers. Occupational safety and health education should be promoted and enforced in all workplaces where CO sources exist.

Comparative Study of Plasma Endotoxin with Procalcitonin Levels in Diagnosis of Bacteremia in Intensive Care Unit Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis of bacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia. The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis of bacteremia in Intensive Care Unit (ICU).</p><p><b>METHODS</b>The medical records of 420 patients in ICU were retrospectively reviewed. Patients (n = 241) who met the inclusion criteria were subjected to blood culture (BC) for the analysis of the endotoxin or PCT levels. The exclusion criteria included the presence of infection with human immunodeficiency virus and/or AIDS, neutropenia without sepsis, pregnancy, treatment with immunosuppressive therapies, or blood diseases such as hematological tumors. Patients' BC episodes were divided into BC negative, Gram-negative (GN) bacteria, Gram-positive bacteria, and fungi groups. The PCT and plasma endotoxin levels were compared in the different groups.</p><p><b>RESULTS</b>A total of 241 patients with 505 episodes of BC were analyzed. The GN bacteria group showed higher levels of PCT and endotoxin than the BC negative, Gram-positive bacteria, and fungi groups. GN bacteremia was more prevalent than Gram-positive bacteremia. The GN bacteremia caused by non-Enterobacteriaceae infection presented higher endotoxin level than that by Enterobacteriaceae, but no significant difference in PCT levels was observed between the two groups. The plasma endotoxin significantly differed among different groups and was bacterial species dependent.</p><p><b>CONCLUSIONS</b>Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia. Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China. And PCT is a more valuable biomarker than endotoxin in the diagnosis of bacteremia.</p>

Rhubarb Antagonizes Matrix Metalloproteinase-9-induced Vascular Endothelial Permeability / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intact endothelial structure and function are critical for maintaining microcirculatory homeostasis. Dysfunction of the latter is an underlying cause of various organ pathologies. In a previous study, we showed that rhubarb, a traditional Chinese medicine, protected intestinal mucosal microvascular endothelial cells in rats with metastasizing septicemia. In this study, we investigated the effects and mechanisms of rhubarb on matrix metalloproteinase-9 (MMP9)-induced vascular endothelial (VE) permeability.</p><p><b>METHODS</b>Rhubarb monomers were extracted and purified by a series of chromatography approaches. The identity of these monomers was analyzed by hydrogen-1 nuclear magnetic resonance (NMR), carbon-13 NMR, and distortionless enhancement by polarization transfer magnetic resonance spectroscopy. We established a human umbilical vein endothelial cell (HUVEC) monolayer on a Transwell insert. We measured the HUVEC permeability, proliferation, and the secretion of VE-cadherin into culture medium using fluorescein isothiocyanate-dextran assay, 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assay, and enzyme-linked immunosorbent assay, respectively, in response to treatment with MMP9 and/or rhubarb monomers.</p><p><b>RESULTS</b>A total of 21 rhubarb monomers were extracted and identified. MMP9 significantly increased the permeability of the HUVEC monolayer, which was significantly reduced by five individual rhubarb monomer (emodin, 3,8-dihydroxy-1-methyl-anthraquinone-2-carboxylic acid, 1-O-caffeoyl-2-(4-hydroxyl-O-cinnamoyl)-β-D-glucose, daucosterol linoleate, and rhein) or a combination of all five monomers (1 μmol/L for each monomer). Mechanistically, the five-monomer mixture at 1 μmol/L promoted HUVEC proliferation. In addition, MMP9 stimulated the secretion of VE-cadherin into the culture medium, which was significantly inhibited by the five-monomer mixture.</p><p><b>CONCLUSIONS</b>The rhubarb mixture of emodin, 3,8-dihydroxy-1-methyl-anthraquinone-2-carboxylic acid, 1-O-caffeoyl-2-(4-hydroxyl-O-cinnamoyl)-β-D-glucose, daucosterol linoleate, and rhein, at a low concentration, antagonized the MMP9-induced HUVEC monolayer permeability by promoting HUVEC proliferation and reducing extracellular VE-cadherin concentrations.</p>

Effect Analysis of the Optimization of Initial Drug Placement in the Automated Drug Dispensing Machine by Minimum Time Algorithm / 中国药房

OBJECTIVE:To optimize the drug placement in the automated drug dispensing machine to improve work efficien-cy. METHODS:Based on the principle of the minimum time algorithm,the drug which would be used at a high frequency was placed in the drug storage tank nearest to the drug outlet. Meanwhile,the rule of drug use was drawn from the information on a large number of prescriptions,based on which the drugs correlated with each other were placed in the drug storage tanks that were adjacent. With daily time it takes to add drugs,average time it takes to make up a prescription and the maximum number of drugs stored as the evaluated indexes,the initial drug placement in the automated drug dispensing machine was optimized. The changes in the indexes within 3 months before and after the above-mentioned optimization were statically analyzed. RESULTS:After calculat-ing the three-dimensional sizes of the packages of drugs and the dispensing frequency data of the previous year,354 drugs were se-lected and placed in the nearer or farther storage tanks in the automated dispensing machine according to the dispensing frequency and the correlation among them. After the optimization of the placement,daily time it takes to add drugs reduced by 54 min(218 vs. 165 min)on average,average time it takes to make up a prescription reduced by 8 s(24 vs.16 s)and the maximum number of drugs stored increased by 1 333 boxes(13 113 vs. 14 446 boxes)on average. There was statistical significance in differences(P<0.05). CONCLUSIONS:The initial drug placement in the automated drug dispensing machine that was optimized by minimum time algorithm has reduced daily time it takes to add drugs and average time it takes to make up a prescription and increased the maximum number of drugs stored and thus improved work efficiency.

Use of Platelet Indices for Determining Illness Severity and Predicting Prognosis in Critically Ill Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Decreased platelet (PLT) count is one of the independent risk factors for mortality in intensive care unit (ICU) patients. This study was to investigate the relationship between PLT indices and illness severity and their performances in predicting hospital mortality.</p><p><b>METHODS</b>Adult patients who admitted to ICU of Changzheng Hospital from January 2011 to September 2012 and met inclusion criteria were included in this study. Univariate analysis was used to identify potential independent risk factors for mortality. Multiple logistic regression analysis was used to calculate adjusted odds ratio for mortality in patients with normal or abnormal PLT indices. The relationship between PLT indices and illness severity were assessed by the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores or sequential organ failure assessment (SOFA) scores in patients with normal and abnormal PLT indices. The performances of PLT indices in predicting mortality were assessed by receiver operating curves and diagnostic parameters. The survival curves between patients with normal and abnormal PLT indices were compared using Kaplan-Meier method.</p><p><b>RESULTS</b>From January 2011 to September 2012, 261 of 361 patients (204 survivors and 57 nonsurvivors) met the inclusion criteria. After adjustment for clinical variables, PLT count <100 × 10 12 /L (P = 0.011), plateletcrit (PCT) <0.108 (P = 0.002), mean platelet volume (MPV) >11.3 fL (P = 0.023) and platelet distribution width (PDW) percentage >17% (P = 0.009) were identified as independent risk factors for mortality. The APACHE II and SOFA scores were 14.0 (9.0-20.0) and 7.0 (5.0-10.5) in the "low PLT" tertile, 13.0 (8.0-16.0) and 7.0 (4.0-11.0) in the "low PCT" tertile, 14.0 (9.3-19.0) and 7.0 (4.0-9.8) in the "high MPV" tertile, 14.0 (10.5-20.0) and 7.0 (5.0-11.0) in the "high PDW" tertile, all of which were higher than those in patients with normal indices. Patients with decreased PLT and PCT values (all P < 0.001), or increased MPV and PDW values (P = 0.007 and 0.003, respectively) had shortened length of survival than those with normal PLT indices.</p><p><b>CONCLUSIONS</b>Patients with abnormally low PLT count, high MPV value, and high PDW value were associated with more severe illness and had higher risk of death as compared to patients with normal PLT indices.</p>

Effects of Rapamycin and Rapamycin-loaded Poly(lactic-co-glycolic)Acid Nanoparticles on Apoptosis and Expression of bcl-2 and p27(kip1) Proteins of Human Umbilical Arterial Vascular Smooth Muscle Cell / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investgate the effects of rapamycin(RPM)and RPM-loaded poly(lactic-co-glycolic)acid(PLGA)nanoparticles(NPs)on the apoptosis of human umbilical arterial vascular smooth muscle cells(HUASMCs)in vitro and expression of bcl-2 and p27(kip1) protein.</p><p><b>METHODS</b>HUASMCs were cultured in vitro and divided to RPM and RPM-PLGA-NPs groups treated at 3 different concentration by 12 and 24 hours,with M231-smooth muscle growth supplements medium and null-PLGA-NPs treated groups as controlled. The apoptosis of HUASMCs was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling staining and flow cytometry. The expressions of bcl-2 and p27(kip1) were detected by streptacidin/peroxidase immunohistochemical method. The effect on cellular proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidecolorimetry.</p><p><b>RESULTS</b>The proliferation of HUASMCs was inhibited by RPM and RPM-PLGA-NPs in a dose-dependent manner. DNA electrophoresis showed DNA ladder in RPM and RPM-PLGA-NPs groups and classical scalar strips in control groups. The apoptotic indexes of RPM 100 ng/ml group and RPM-PLGA-NPs 500 ng/ml group detected by flow cytometry were(45.45<2.36)% and(35.04<5.64)%,respectively,which were significantly higher than that of M231-smooth muscle growth supplements control group [(2.60<0.95)%,all P<0.01]. The apoptotic indexes of groups incubated with RPM and RPM-PLGA-NPs for 24 hours were significantly higher than those of groups which incubated for 12 hours(P<0.05,P<0.01). The positive expression indexes(PEI)of p27(kip1) and bcl-2 protein were higher in RPM and RPM-PLGA-NPs groups than that of control groups. The Spearman's rank correlation coefficient test showed that there was no significant correlation between the PEI of p27(kip1) and the apoptotic indexes in the RPM group and RPM-PLGA-NPs group(P>0.05).</p><p><b>CONCLUSIONS</b>Rapamycin-loaded PLGA nanoparticles and rapamycin have similar effects in inhibiting proliferation and inducing apoptosis;meanwhile,they upregulate the expression of p27(kip1) protein without downregulating the expression of bcl-2 protein in HUASMCs in vitro. RPM-PLGA-NPs has more potent pro-apoptotic effect than equivalent dose of RPM but is not linearly correlated with the p27(kip1) expression level.</p>

Assessment of the left ventricular early diastolic synchrony of cardiac resynchronization therapy by real time three-dimensional echocardiographic volume-time curves in patients with dilated cardiomyopathy / 中华超声影像学杂志

Objective To evaluate the diastolic function and relationship between diastolic function and early diastolic synchrony in patients with dilated cardiomyopathy (DCM) by real-time three-dimensional echocardiography (RT-3DE) volume-time curves (VTC) after cardiac resynchronization therapy (CRT).Methods Thirty-nine patients with DCM were enrolled by RT-3DE VTC before and 1 week,6 months,12 months after CRT,draw the left ventricular (LV) 16,12,6 segments LV diastolic early volume standard deviation of the time (Tedv-SD),and with the R-R interval normalized as early diastolic unsynchronized index (DDI) ;draw end-systolic volume (LVESV),LV end-diastolic volume (LVEDV),LV ejection fraction (LVEF) ;and calculate the diastolic peak filling rate(PFR),the ratio of early diastolic volume and enddiastolic volume(EDVearly/EDV).Results LVEDV,LVESV had no significant improvement.Compared with the before and 1 week after CRT,but the improvement was statistically significant after 6 months and 12 months (P ＜0.05,P ＜0.01); LVEF after 1 week,6 months and 12 months were statistically significant (P ＜0.05) ;Compared with before,PFR after 6 months was significantly increased (P ＜0.05),EDVearly/EDV at 12 months after CRT was significantly reduced (P ＜ 0.01); There was a significantly shortened in each segment (Tedv-SD)/R-R 1 week after CRT (P ＜0.01),but the parameters had no obvious improvement later.Correlation analysis:△ DDI and △ EDVearly/EDV reduction was significant positive correlation (r =0.52,P ＜0.01),△DDI and PFR has negative correlation (r =-0.40,P ＜ 0.05),△ EDVearly/EDV and △PFR also had a good relationship (r =-0.56,P ＜0.01).Conclusions The LV synchrony and diastolic function were improved after CRT in patients with DCM; PFR,EDVearly/EDV can be used as evaluation of left ventricular diastolic function effectively targets.