Construction of a prediction model for prognosis of severe pneumonia patients combined with sepsis / 中华临床感染病杂志

Objective:To construct a prediction model for prognosis of severe pneumonia patients combined with sepsis.Methods:Clinical data of 318 severe pneumonia patients combined with sepsis admitted at Taizhou People’s Hospital affiliated to Nanjing Medical University from March 2019 to March 2022 were retrospectively analyzed. Patients were randomized into a modeling set ( n=233) and a validation set ( n=85) with a 3∶1 ratio. In the modeling set there were 180 survival cases and 53 fatal cases according to the clinical outcomes within 30 days of admission. Multivariate Cox regression analysis was used to evaluate the independent prognostic factors for patients in the modeling set. A nomogram prediction model was constructed by R based on these prognostic factors and further verified using the data of the validation set with receiver operating curve (ROC), decision curve analysis (DCA), and calibrated with calibration curve analyses. Results:Multivariate Cox regression analysis suggested that septic shock ( HR=2.32, 95% CI 1.37-3.89, P=0.013) and neutrophil/lymphocyte ratio (NLR) ( HR=2.52, 95% CI 1.23-5.61, P=0.017) were independent risk factors for mortality in severe pneumonia patients combined with sepsis within 30 days of admission, while albumin/fibrinogen ratio (AFR) ( HR=0.64, 95% CI 0.41-0.83, P=0.011) and prognostic nutritional index (PNI) ( HR=0.68, 95% CI 0.57-0.83, P=0.009) were independent protective factors. The area under ROC curve (AUC) of the nomogram model based on these four indicators in the modeling and validation sets were 0.875 and 0.880, respectively. The DCA curve analysis indicated that the clinical benefit of this model was better than "All" or "None" curves in both the modeling and verification sets.The calibrate curve analysis indicated that the actual and corrected curves fitted well and were close to the ideal curve. Conclusion:The constructed nomogram model based on septic shock, AFR, NLR and PNI has a well prognostic value in severe pneumonia patients combined with sepsis.

Prescription Law of New Coronavirus Pneumonia in Different Stages / 中国实验方剂学杂志

Objective:To study the clinical medication regulation for the prevention and treatment of new coronavirus pneumonia with traditional Chinese medicine（TCM），especially prescriptions，on the basis of "treatment in accordance with seasonal conditions". Method:The guidelines and suggestions on novel coronavirus pneumonia formulated and published by national，provincial and municipal governments and experts before February 17，2020, were retrieved and summarized. Data was recorded in stages according to "prevention period，clinical observation period，pre-clinical period，middle clinical period，late clinical period and recovery period". The frequency analysis of TCM and its efficacy，prescription and proprietary Chinese medicine was carried out，and then the factor analysis and cluster analysis of TCM were carried out to obtain rational drug combinations. Result:Totally 172 suggestions on combined structure of drugs，50 suggestions on prescriptions and 31 suggestions on proprietary Chinese medicine were involved in the study，and provided by 24 official agencies and 24 medical experts， 147 kinds of herbs，44 prescriptions and 16 proprietary Chinese medicines were collected. No matter for the drug category or for the specific drug selection，the law of drug use in different stages was not the same. Huoxiang Zhengqi capsule，Shufeng Jiedu capsule，Lianhua Qingwen capsule and Jinhua Qinggan capsule can be used in the observation period. Xuanbai Chengqitang can be used in the middle of the disease. Angong Niuhuangwan，Suhexiangwan or Zixuedan, and Angong Niuhuangwan can be selected in the middle of the disease. And Qingfei Paidu decoction can be used in all stages of the disease. Conclusion:Doctors need to adjust their prescriptions along with the progress of the disease，because the law of medication in each stage of the new coronavirus pneumonia is different.

A Comparative Study of PBPK Model and Allometric Growth Model of Azithromycin in Extrapolation of Adult Pharmacokinetic Data to Pediatric Population / 中国药学杂志

OBJECTIVE: To establish an adult-pediatric transformation model of azithromycin to provide guiding recommendations for clinical using of pediatrics, reduce the risk of medicationfor children, and achieve clinical personalized medication for children. METHODS: The relevant literature was reviewed. The physiological parameters of the azithromycin oral administration test in adults combined with the drug-specific parameters of azithromycin were used to establish an allometric growth model, PBPK model. According to the clinical data of oral azithromycin extracted from individual children, the correctness of the parameter scaling formulas of these two models was verified. These two models were further used to simulate the pharmacokinetic parameters of children and calculate the relative deviation and relative standard error of these parameters. RESULTS: Through simulation, it is found that the pharmacokinetic parameters cmax, tmax, AUC0-∞ obtained by the two models are close to the measured values, which are all within the scope of the literature. It can be considered that the parameter conversion formulas of the two models are correct. Further, the relative deviation and relative standard error of the parameters are calculated, and the relative deviation and relative standard error of the adult-pediatric PBPK prediction model are smaller than those of the allometric growth model. CONCLUSION: The azithromycin PBPK model predicts that children's pharmacokinetic parameters are better than the allometric growth model. The scaling formula for the specific parameters of the oral-dose adult-child model used in this article, which was successfully verified by azithromycin, can be extrapolated to other drugs to facilitate the conversion of other oral-adulterated adult-pediatric models.

Clinical efficacy and safety of thrombolytic treatment with reteplase in patients with intermediate-risk acute pulmonary embolism / 中华心血管病杂志

Objective@#To assess the efficacy and safety of thrombolytic treatment with reteplase in patients with intermediate-risk acute pulmonary embolism.@*Methods@#Ten consecutive patients with intermediate-risk acute pulmonary embolism who received thrombolytic treatment with reteplase at Thrombosis and Vascular Medicine Center, Fuwai Hospital from March to November in 2016 were included.Vital signs, right ventricular diameter, systolic pulmonary artery pressure, and biochemical markers were assessed before and after thrombolytic therapy with reteplase, and bleeding complications were also observed during 3 months follow up.@*Results@#(1) For the efficacy outcomes: at 48 hours after thrombolytic treatment with reteplase, echocardiography-derived diameter of right ventricular was significant reduced from (27.9±3.8) mm to (24.8±2.6) mm (P=0.03), systolic pulmonary artery pressure decreased from (63.9±21.6) mmHg(1 mmHg=0.133 kPa) to (34.4±19.8) mmHg (P=0.02). Heart rate and breathing rate were also decreased significantly (both P<0.05), blood pressure remained unchanged post therapy.Hypoxemia was quickly corrected with an significant elevation of PaO2 and SaO2 ((65.2±14.3) mmHg vs. (80.0±9.6) mmHg, P=0.006; (90.8±3.5)% vs. (95.2 ±1.6)%, P=0.002 respectively). PaCO2 was also increased significantly (P<0.05). Serum NT-proBNP and cTnI were decreased significantly (both P<0.05). There was no recurrent pulmonary embolism or deep-vein thrombosis during the 3 months follow-up. (2) For the safety outcomes: a thrombolytic relevant hemoptysis (about 70 ml) occurred in 1 patient, and was controlled by PCC therapy.No other clinically relevant events were observed during thrombolytic treatment. Eight patients were followed more than 3 months, there was no major bleeding complication or death during the follow up period.@*Conclusion@#Treatment of intermediate-risk acute pulmonary embolism with reteplase is effective and safe and there are no obvious side effects.

The effects of Bucinnazine Hydrochloride on the pain behavior and expression of caveolin-1 in anterior cingulate cortex of neuropathic pain mice / 中华行为医学与脑科学杂志

Objective To investigate the effects of Bucinnazine Hydrochloride on the pain behavior and the expression of caveolin-1 (Cav-1) in the anterior cingulate cortex of neuropathic pain mice.Methods 64 adult male Kunming mice (20-25g) were divided randomly into 4 groups with 16 in each group:Sham+BH(Bucinnazine Hydrochloride) group,Sham+NS (Normal Saline) group,CCI+ BH group and CCI+ NS group.The corresponding drugs were administered by intraperitoneal injectionfrom the forth day after CCI once a day for three days.Paw thermal withdrawal latency was measured by Hargreaves methods.Mechanicalwithdrawal threshold was assayed by electronic dolorimeter.c-Fos protein in anterior cingulate cortex was detected by immunohistochemistry staining and the expression of t-Cav-1,p-Cav-1was detected by Western blot.Results Bucinnazine Hydrochloride administered by intraperitoneal injection(0.1 mg/10 g,mice) alleviated thermal hyperalgesia and mechanical allodynia of CCI mice.Compared with the forth day (4.92±0.41) s of CCI+BH group,paw withdrawal latency on the fifth day(5.92±0.61) s was increased(P＜0.05),and on the sixth day(7.93±0.91) s and seventh day (9.12±0.69)s were increased more(P＜0.01,P＜0.01).The paw withdrawal mechanical threshold on the sixth and seventh day of CCI+BH group mice((2.54 ±0.41)g,(3.68±0.61)g) were increased significantly (P＜0.01,P＜0.01)compared with the forth day(1.55± 0.31)g.Immunohistochenistry results showed that the expression of c-Fos decreased after treated with Bucinnazine Hydrochloride in the anterior cingulate cortex of CCI mice(P＜0.001).Western Blotting showed that the expression of t-Cav-1 (1.97±0.31) and p-Cav-1 (0.11 ±0.09) in the anterior cingulate cortex of CCI +BH group mice decreased compared with that of in CCI+NS group mice(t-Cav-1:2.87±0.15,p-Cav-1:0.48± 0.09) (P＜0.01,P＜0.01).Conclusion Bucinnazine Hydrochloride can alleviate both thermal hyperalgesia and mechanical allodynia of neuropathic pain of mice,and reduce the expression of c-Fos,t-Cav-1,p-Cav-1 in the anterior cingulate cortex of neuropathic pain mice.

Analysis of Essential Thrombocythemia Combining Myocardial Infarction in 10 Patients / 中国循环杂志

Objective: To analyze the characteristics, treatment and prognosis in patients with essential thrombocythemia (ET) combining myocardial infarction (MI). Methods: A total of 10 patients with ET combining MI treated in our hospital from 2003-01 to 2015-07 were retrospectively studied. The basic clinical information with major admission complaints, previous history and peripheral platelet counts were recorded;echocardiograph, coronary angiography (CAG), application of anti-platelet drugs and platelet reductive therapy with the prognosis were recorded in all patients. Results: There were 6 male and 4 female with a mean age of (55.3 ± 9.7) years, 7 patients with AMI and 3 with old MI. The platelet counts at admission were (500-599) × 109/L in 3 patients, (600-699) × 109/L in 1 patient, (700-799) × 109/L in 3 patients, (800-899) × 109/L in 1 patients, (900-999) × 109/L in 1 patient and more than 1000 × 109/L in 1 patient. Echocardiograph indicated that 5 patient had LVEF≤50%and 5 had LVEF>50%. CAG revealed that there were 9 cases with left anterior descending involved, 2 with circumlfex involved and 5 with right coronary involved. All patients received dual anti-platelet drugs before operation, 4 had hydroxyurea for (20-30) days before operation and no post-operative cardiovascular events occurred;6 patients without hydroxyurea medication and 1 of them was re-hospitalized for angina pectoris and 2 had progressed coronary lesions. Conclusion: Application of platelet reductive therapy at before and after interventional treatment may improve the prognosis in patients with ET combining MI.

A Polysomnography Study of Kleine-Levin Syndrome in a Single Center / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Kleine-Levin syndrome (KLS) is a rare sleep disorder characterized by recurrent episodes of hypersomnia. Polysomnographic (PSG) researches of KLS have been reported only in few publications in the past decades. This study aimed to investigate the characteristics of PSG of KLS.</p><p><b>METHODS</b>This study, which was conducted from March 2010 to July 2014, included seven patients diagnosed with KLS in the Sleep and Wake Disorder Center of Huashan Hospital, Fudan University (Shanghai, China). PSG and multiple sleep latency tests (MSLT) were performed during their episodes and the results were evaluated.</p><p><b>RESULTS</b>Five of the seven patients were males. The mean age at KLS onset was 15.6 ± 3.6 years. The number of episodes ranged from 2 to 7. The duration of episodes lasted from 4 to 11 days. The sleep architecture and proportion were normal in most of the patients. The average value of mean sleep latency was 6.9 ± 4.1 min. No sleep-onset rapid eye movement (SOREM) was detected in three of the patients, whereas one patient experienced one period of SOREM, and such episodes occurred twice in other two patients.</p><p><b>CONCLUSIONS</b>We found that sleep architecture and proportion were normal in most KLS patients. However, the results of PSG and MSLT had no specificity for KLS patients.</p>

Plasma α1-antitrypsin: a neglected predictor of angiographic severity in patients with stable angina pectoris / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As an acute phase protein, α1-antitrypsin (AAT) has been extensively studied in acute coronary syndrome, but it is unclear whether a relationship exists between AAT and stable angina pectoris (SAP). The purpose of the present study was to investigate the association between AAT plasma levels and SAP.</p><p><b>METHODS</b>Overall, 103 SAP patients diagnosed by coronary angiography and clinical manifestations and 118 control subjects matched for age and gender were enrolled in this case-control study. Plasma levels of AAT, high-sensitivity C-reactive protein (hsCRP), lipid profiles and other clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the Gensini score (GS) assessed by coronary angiography.</p><p><b>RESULTS</b>Positively correlated with the GS (r = 0.564, P < 0.001), the plasma AAT level in the SAP group was significantly higher than that in the control group (142.08 ± 19.61 mg/dl vs. 125.50 ± 19.67 mg/dl, P < 0.001). The plasma AAT level was an independent predictor for both SAP (odds ratio [OR] = 1.037, 95% confidence interval [CI]: 1.020-1.054, P < 0.001) and a high GS (OR = 1.087, 95% CI: 1.051-1.124, P < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, plasma AAT level was found to have a larger area under the curve (AUC) for predicting a high GS (AUC = 0.858, 95% CI: 0.788-0.929, P < 0.001) than that of hsCRP (AUC = 0.665, 95% CI: 0.557-0.773, P = 0.006; Z = 2.9363, P < 0.001), with an optimal cut-off value of 137.85 mg/dl (sensitivity: 94.3%, specificity: 68.2%).</p><p><b>CONCLUSIONS</b>Plasma AAT levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.</p>

Clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce the clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot.</p><p><b>METHODS</b>Based on the anastomoses between the medial plantar artery of the hallux and the nutritional vein, the flap was designed with the perforator of medial plantar artery adjacent to the first metatarsal bone as the rotation point. The flap axis was along the vein at the medial aspect of the foot between rotation point and medial malleolus.</p><p><b>RESULTS</b>5 cases were treated with primary healing and complete survival flaps. The patients were followed up for 1-12 months with good match of texture and color.</p><p><b>CONCLUSIONS</b>The venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot can be transpositioned to repair the defect at forefoot.</p>

Scalp expanded flap combined with IPL hair removal for large area scar on forehead / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of scalp expanded flap combined with JPL hair removal for large area scar on forehead.</p><p><b>METHODS</b>From Jul. 2010 to Nov. 2012, 9 cases with large area scar on forehead received treatment of adjacent scalp expanded flap combined with JPL hair removal. One the first stage, the expander was implanted under the scalp near the forehead scar, followed hy expansion process. When the expansion was completed, the expanded flap was transferred to cover the wound after scar excision. 10 days after flap transposition, the forehead hair line was designed and extra hair on flap underwent JPL hair removal. After 3-5 treatments, the hair on flap was almost removed.</p><p><b>RESULTS</b>All the scalp flaps survived completely. JPL hair removal had exact effect. The patients were followed up for 5-11 months. The hair density on the flap decreased hy more than 90%. The flap had a good match with surrounding facial skin in color, texture and thickness. The reconstructed forehead hair line was satisfactory.</p><p><b>CONCLUSIONS</b>It is a good option to reconstruct large area scar on forehead with scalp expanded flap comhined with IPL hair removal.</p>

Analysis for Combined Use of Low Molecular Weight Heparin and Statins Causing Transaminase Elevation in 32 Patients / 中国循环杂志

Objective: To analyze the relevant factors for combined use of low molecular weight heparin (LMWH) and statins causing transaminase elevation and to provide the reference for medication safety in clinical practice. Methods: There were 45 patients who received the combination of LMWH and statins treatment, then having ALT elevation in our ward from 2011-01 to 2012-12 were collected, by exclusion of patients with the history of high ALT at admission, interrupted treatment and incomplete record of liver function tests, a total of 32 patients were ifnally enrolled for investigation. The conditions for using LMWH and statins together, type of LMWH, timing of ALT elevation after medication and clinical outcomes were retrospectively analyzed. Results: All patients received statins including simvastatin, atorvastatin, rosuvastatin and pravastatin, and 15 patients took statins before using LMWH including enoxaparin, nadroparin and dalteparin. There were 18 patients had ALT increased below 3 times of the upper limit and 14 patients had ALT level ≥ 3 times of the upper limit, and ALT elevation occurred at the average of (3 ± 3.8) days after taking LMWH. All patients stopped using LMWH upon ALT elevation and 16 of them stopped taking statins. The ALT level gradually decreased to normal by application of hepatic-protective treatment in all patients.Conclusion: Combined using LMWH and statins could cause ALT elevation, LMWH and statins may have synergistic effect, and therefore, the enhanced monitor of liver function is necessary when using the combined medication.

Relationship Between Erythrocyte Sedimentation Rate and Myocardial Infarction Occurrence in Patients With Rheumatoid Arthritis Combining Coronary Artery Disease / 中国循环杂志

Objective: To explore the relationship between erythrocyte sedimentation rate (ESR) and myocardial infarction (MI) occurrence in patients with rheumatoid arthritis (RA) combining coronary artery disease (CAD). Methods: A total of 106 consecutive patients with RA combining CAD were studied. There were 46 male and 60 female patients and divided into 2 groups:RA with MI group, n=46 and RA without MI group, n=60. The base line condition was compared between 2 groups, and multivariate regression analysis was conducted to explore the risk factors for MI occurrence in relevant patients. Results: Compared with RA without MI group, RA with MI group had the lower level of cholesterol and higher levels of inlfammatory indexes of ESR, high sensitivity C-reactive protein (hs-CRP) and CRP, P0.05. Multivariate regression analysis indicated that ESR was the independent risk factor of MI occurrence, OR=1.024, 95%CI 1.024 (1.007-1.043), P=0.007. Conclusion: ESR was independently related to MI occurrence in patients with RA combining CAD.

Analysis of Allergic Adverse Reaction Caused by Non-ionic Iodinated Contrast Media in 52 Patients With Coronary Angiography / 中国循环杂志

Objective: To analyze the current status of allergic adverse reactions caused by non-ionic iodinated contrast media in patients with coronary angiography (CAG). Methods: A total of 1 225 patients who received non-ionic iodinated contrast media for CAG in our hospital from 2011-02 to 2013-09 were retrospectively studied. There were 52 patients suffered from allergic adverse reactions including 47 (90.38%) male and 5 (9.62%) female. The allergic reaction to iodixanol, iohexol, iopamidol and iopromide were in 34, 3, 3 and 12 patients respectively. The clinical symptoms and outcomes of allergic reaction in 4 iodinated contrast media were analyzed. Results: There were 40/52 (76.92%) patients with mild allergic reaction, 11(21.15%) with moderate and 1 (1.92%) with severe reaction. 13 patients had the reaction within 1 hour of contrast media injection and 39 had the reaction between 1 hour to 3 days of contrast media injection. There 34 patients were cured by symptomatic and anti-allergic treatment, 1 patient was rescued from allergic shock and no death occurred. Conclusion: Application of non-ionic iodinated contrast media in CAG is safe, while closely observe the allergic adverse reaction with the in time and symptomatic treatment is very important in clinical practice.

Effect of Cytochrome P-450 4F2 Gene Polymorphisms in Patients With Warfarin for Initial Doses in 7 Days / 中国循环杂志

Objective: To study the effect of cytochrome P-450 4F2 (CYP4F2, rs2108622) gene polymorphisms in patients with warfarin for initial doses in 7 days. Methods: A total of 271 patients treated by warfarin were studied. The CYP4F2 gene polymorphisms were assessed by real-time PCR, the average initial warfarin doses in 7 days and the time of international normalized ratio (INR) ifrst arrived to therapeutic range were recorded. The differences of initial warfarin doses and the time of INR ifrst arrived to therapeutic range among CYP4F2 gene polymorphisms of CC, CT and TT genotypes were analyzed by statistical method. Results: The average initial warfarin doses among CYP4F2 polymorphisms of TT and CT/TT were higher than CC, P Conclusion: CYP4F2 polymorphisms inlfuenced the initial warfarin doses in 7 days in relevant patients.

Comparative Study for the Patients of Hypertensive Hypertrophic Cardiomyopathy in Elder age and the Patients of Hypertensive Left Ventricular Hypertrophy / 中国循环杂志

Objective: To compare the clinical characteristics and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) between the patients with hypertensive hypertrophic cardiomyopathy in elder age (HHCME) and the patients with hypertensive left ventricular hypertrophy (HTN-LVH). Methods: Our work included 2 groups, HHCME group,n=47 and HTN-LVH group,n=44. Duplex Doppler echocardiography was performed to determine left atrial diameter (LAd), left ventricular end-diastolic dimension (LVEDd), interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), velocity of early diastolic period (VE) and velocity of end-diastolic period (VA) in mitral valve oriifce. Plasma level of NT-proBNP was measured by ELISA. The above indexes were compared between 2 groups. Results:①Compared with HTN-LVH group, HHCME group presented decreased LVEDd and increased IVST, LVEF, allP0.05.②Plasma level of NT-proBNP was higher in HHCME group,P Conclusion: The plasma NT-proBNP level was higher in HHCME patients than that in HTN-LVH patients which indicated that HHCME patients may have worse prognosis. NT-proBNP might be helpful for differencing HHCME.

Establishment and preliminary validation of warfarin maintenance dose algorithm in Chinese Han Population / 中华心血管病杂志

<p><b>OBJECTIVES</b>To establish an algorithm to predict the warfarin maintenance dose in Chinese Han population and validate the accuracy of this algorithm.</p><p><b>METHODS</b>A total of 488 Chinese Han patients, hospitalized in Fuwai hospital and had a stable dose of warfarin and a target international normalized ratio (INR) of 1.5 to 3.0, were recruited. Indications for warfarin use included prosthetic heart valve, atrial fibrillation and pulmonary embolism. These patients were divided into derivation group (n = 323) and validation group (n = 165) according to the enrollment time. A warfarin maintenance dose algorithm was established based on genetic information, demographic characteristics and concomitant medications by multiple linear regression analysis in derivation group. In the validation group, we evaluated the accuracy of our algorithm by comparing the predicted dose with the actual dose.</p><p><b>RESULTS</b>Our algorithm included VKORC1-1639G > A, CYP2C9*3 and CYP4F2 genotype, age, Body hight, body weight, amiodarone and digoxin use (R(2) = 0.652, P < 0.001) .In the validation group, the average predicted dose by our algorithm had no statistical difference with the actual dose [(3.51 ± 1.03) mg vs. (3.53 ± 1.41) mg, P = 0.779]. Our algorithm identified 100 out of 165 (60.6%) patients in the validation group, whose predicted dose of warfarin was within 20% of the actual dose, and predicted warfarin dose was underestimated in 17.6% (29/165) patients and overestimated in 21.8% (36/165) patients.</p><p><b>CONCLUSION</b>Our algorithm based on VKORC1, CYP2C9 and CYP4F2 polymorphisms can help to predict the warfarin maintenance dose in Chinese Han Population.</p>

Comparison of effectiveness and safety of different treatment modes for limited-stage small cell lung / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness and safety of different treatment modes for limited-stage small cell lung cancer(SCLC).</p><p><b>METHODS</b>The clinical data of 171 SCLC patients who had received different therapies were retrospectively analyzed.</p><p><b>RESULTS</b>Of these 171 patients,55 had received concurrent radiochemotherapy,66 received sequential radiochemotherapy,and 50 received chemotherapy alone. For these 171 patients,the overall response rate(ORR)was 73.1%,overall survival(OS)and progression-free survival(PFS)were 23.5 months and 15.2 months,respectively,and the 1-,3-,and 5-year survival rates were 76.2%,30.4%,and 16.3%,respectively. For the concurrent group,sequential group,chemotherapy alone group,the median OS were 30.6,23.1,and 19.1 months,the median PFS were 19.7,13.3,and 11.5 months,and the 5-year survival rate was 28.7%,13.6%,and 9.4%,respectively(all P<0.05). The main toxic effects were myelosuppression,radiation pneumonia,and radiation esophagitis. The incidences of 1-2 grade myelosuppression were 92.7%,89.4%,and 92% in the concurrent group,sequential group,and chemotherapy alone group(P=0.25). For concurrent group and sequential group,the incidence of 1 grade radiation pneumonia were 47.2% and 50%,respectively(P=0.61),whereas the incidence of 1-2 grade radiation esophagitis were 94.5% and 75.8%(P=0.02). Multivariate analysis showed that gender,ECOG score,TNM stage,and thoracic radiation therapy were the independent prognostic factors for SCLC.</p><p><b>CONCLUSION</b>Concurrent radiochemotherapy is the treatment of choice for SCLC patients because it can improve the survival with tolerable toxicities.</p>

Small endoscopic sphincterotomy plus large-balloon dilation for removal of large common bile duct stones during ERCP

This study compared the therapeutic benefits and complication rates of small endoscopic sphincterotomy plus large-balloon dilation [ESLBD] with those of endoscopic sphincterotomy [EST] alone for large bile duct stones. We compared prospectively ESLBD group [n=63] with conventional EST group [n=69] for the treatment of large bile duct stones [>/= 15mm]. Mechanical lithotripsy was performed when the stone could not be removed using a normal basket. We compared the rates of stone removal, frequency of mechanical lithotripsy use, procedure-related complications, and recurrent stones. A total of 132 patients were reviewed in the study. The mean age of the patients was 67.9 years. The two groups showed significant differences in complete stone removal during the first session [80.9 vs. 60.8%; P = 0.046], the use of mechanical lithotripsy [7.94 vs. 24.6%; P = 0.041], and less duration of admission [P =0.045]. After ERCP, there were some instances of oozing in both groups, All patients recovered completely, 14 patients had recurrent common bile duct stones among the follow-up duration. The ESLBD technique seems to be a feasible and safe alternative technique for conventional EST and EBD and has no more Post-ERCP complications

Therapeutic efficacy of three-dimensional conformal radiation therapy for patients with locally advanced non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the treatment results of three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (2D) for patients with locally advanced non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>Five hundred and twenty seven patients with stage III NSCLC treated between Jan 2000 and Dec 2006 were included in this study. Among them, 253 cases were treated with 3D-CRT, and 274 with conventional radiotherapy. In the 3D group, 159 (62.8%) patients received chemoradiotherapy, 77 with total radiotherapy dose of > 60 Gy, 49 with 50 - 60 Gy. In the 2D group, 127 (46.4%) patients received chemoradiotherapy, 48 with total radiotherapy dose of > 60 Gy, 75 with 50 - 60 Gy.</p><p><b>RESULTS</b>The 1-, 3-, 5-year overall survival rates (OS) and median survival time for patients treated with 3D-CRT were 73.3%, 26.1%, 14.4% and 20.1 months, respectively, and that of patients treated with 2D radiotherapy were 61.0%, 13.8%, 8.0% and 15.6 months, respectively (P = 0.002). The 1-, 3-, 5-year cause-specific survival rates (CSS) were 79.0%, 33.3%, and 20.8% for the 3D group and 65.1%, 16.7%, 11.2%, respectively, for the 2D group (P = 0.000). The 1-, 3-, and 5-year locoregional control rates were 71.6%, 34.3% and 31.0% for patients treated with 3D radiotherapy and 57.3%, 22.1% and 19.2%, respectively, for patients treated with 2D treatment (P = 0.002). The results of multivariate analysis showed that 3D-CRT, KPS, clinical tumor response and pretreatment hemoglobin level were independently associated with increased OS and CSS. No statistically significant differences were found between the radiation complications in the two groups.</p><p><b>CONCLUSIONS</b>The results of our study demonstrate that 3D-conformal radiotherapy improves the survival rate in patients with stage III NSCLC compared with that of 2D radiation therapy.</p>

A rare case of tricuspid valve thrombus with acute pulmonary embolism / 中华医学杂志(英文版)

The development of thrombus on the tricuspid valve is very rare. This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart, detected by bedside transthoracic echocardiography (TTE). After successful surgical management, the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus. The early use of bedside TTE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected.