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Objective:To explore the influencing factors of severity of upper gastrointestinal bleeding (UGIB) and to establish the early warning evaluation model in the form of line chart, so as to provide a feasible basis for emergency nurses' triage.Methods:A total of 680 UGIB patients admitted to the Emergency Department of the First Affiliated Hospital of Wenzhou Medical University from January 2019 to January 2020 were retrospectively analyzed. They were divided into a modeling group ( n=510) and a validation group ( n=170) by random number table method, and were divided into a high-risk group and a low-risk group according to the expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding in 2020. The differences of various indicators between groups were compared, the factors affecting the severity of the disease were analyzed by Logistic regression, and the nomogram was drawn and validated. Results:Multivariate logistic regression analysis showed that hematemesis ( OR=3.875, 95% CI: 2.212-6.79), diabetes ( OR=2.64, 95% CI: 1.184-5.883), syncope ( OR=10.57, 95% CI: 3.675-30.403), heart rate ( OR=3.262, 95% CI: 1.753-6.068), red blood cell distribution width ( OR=3.904, 95% CI: 2.176-7.007), prothrombin time ( OR=3.665, 95% CI: 1.625-8.269), lactic acid ( OR=3.498, 95% CI: 1.926-6.354) and hemoglobin ( OR=4.984, 95% CI: 2.78-8.938) were the influencing factors of the severity of UGIB patients ( P < 0.05). The nomogram model showed good consistency and differentiation (C-index=0.903, 95% CI: 0.875-0.931), and was verified internally (C-index=0.895) and Hosmer-Lemeshow goodness-of-fit test ( P=0.7936). Externally verified C-index was 0.899 (95% CI: 0.846-0.952). The calibration curve prompt warning evaluation model had good stability and the prediction efficiency was better than the modified early warning score ( P < 0.05). Conclusions:The early warning evaluation model has a reliable predictive value, which can provide a reference for emergency medical staff to screen high-risk patients and formulate targeted nursing interventions.
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Objective For bioequivalence test of the consistency evaluation of generic drug products,providing a reference of varieties of biowaiver.Methods Based on Human bioequivalence test waiver guidelines (draft),on condition that first drug of the consistency evaluation,to introduce and conclude briefly the standards of biowaiver and varieties of biowaiver in FDA,WHO and EMA.Results Contrast to FDA,there are 59 varieties applied for the waiver and 19 varieties not applied for the waiver in the 289 varietie;compared to WHO,10 drugs are exempted and 1 grug is exempted in EMA.Conclusion At present,the specific list of drugs are not published of biowaiver in our country,the pharmaceutical companies should compare and consult revelant standards and specific drugs in China and abroad,to speed up the progress of the consistency evaluation.
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Objective@#To investigate the relationship between M2-polarized macrophages and early response in multiple myeloma and its molecular mechanism.@*Methods@#Two hundred and forty bone marrow biopsy tissue were collected and M2-polarized macrophages were stained by anti-CD163 monoclonal antibody. In vitro M2-polarized macrophages were derived from human peripheral blood mononuclear cell or THP-1 cells and identified by flow cytometry. Two myeloma cell lines RPMI 8226 and U266 were co-cultured with M2 macrophages using a transwell system. We measured myeloma cells proliferation through CCK-8 method and the pro-inflammatory cytokines expression (TNF-α and IL-6) by ELISA. Real time PCR was applied to measure chemokines (CCL2 and CCL3) , chemokine receptors (CCR2, CCR5) , VEGF and their receptors. In addition, flow cytometry was used to analyze the apoptosis of myeloma cells induced by dexamethasone.@*Results@#①Patients with high percentage of M2 macrophage involvement in bone marrow showed poorer response (23.9% versus 73.0%, χ2=60.31, P<0.001). ② In vitro the proliferation of RPMI 8226 cells (P=0.005 at 24 h, P=0.020 at 36 h) or U266 myeloma cells (P= 0.030 at 24h, P=0.020 at 36h) co-cultured with M2-polarized macrophages was higher than control group. ③In vitro the apoptotic rate of RPMI 8226 cells (29.0% versus 71.0%, t=4.97, P=0.008) or U266 myeloma cells (24.9% versus 67.7%, t=6.99, P=0.002) co-cultured with M2-polarized macrophages was lower than control group. ④ In vitro M2-polarized macrophages promoted myeloma cells secreting higher level of IL-6, TNF-α and higher expression of CCL2, CCL3, CCR2, CCR5, VEGFA, VEGFR-1,-2 compared with the non-macrophage co-culture system.@*Conclusion@#M2-polarized macrophages promote myeloma cells proliferation and inhibit apoptosis through a very complex mechanism involving pro-inflammatory cytokines IL-6 and TNF-α, chemokines and related receptors such as CCL2, CCL3, CCR2, CCR3, and VEGF as well as related VEGFR.
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Objective To evaluate the value of semi-quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI)in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma.Methods Forty-four patients with pathologically confirmed laryngeal and hypopharyngeal squamous cell carcinoma were collected.Time signal intensity curves (TIC)and related semi-quantitative parameters were obtained before (point 1 ),during (point 2)and after (point 3 )treatment. Tumor remission were assessed at the end of treatment and the statistical analyses were performed using SPSS.Results Twenty two patients had a complete remission as CR group and 22 had a partial remission as PR group.The parameters of time to peak (TTP), maximum signal enhancement ratio (SERmax ),positive enhancement integral (PEI),SER70 and SER84 at point 1 were higher than those at point 2,and there were significant differences between two groups (P <0.05).The values of SERmax ,SER42 ,SER56 ,SER70 and SER84 before treatment were higher in CR group than those in PR group,exhibiting significant differences between two groups (P <0.05).ROC curve analysis showed the threshold for SER56 was set to ≥129.4％ to predict complete remission,and the sensitivity and specificity were 60％ and 86.4％,respectively.Comparison of remission rates among different types of TIC showed complete remission rates in typeⅠTIC and type Ⅲ TIC were 87.5％ and 39.3％,respectively,exhibiting a significant difference between two groups (P =0.041). Conclusion TIC types and semi-quantitative parameters of DCE-MRI can predict therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma,SER56 is the most important predictive semi-quantitative parameter,and prognosis is much better in typeⅠTIC than type Ⅲ TIC before treatment.
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Objective To evaluate the value of semi-quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI)in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma.Methods Forty-four patients with pathologically confirmed laryngeal and hypopharyngeal squamous cell carcinoma were collected.Time signal intensity curves (TIC)and related semi-quantitative parameters were obtained before (point 1 ),during (point 2)and after (point 3 )treatment. Tumor remission were assessed at the end of treatment and the statistical analyses were performed using SPSS.Results Twenty two patients had a complete remission as CR group and 22 had a partial remission as PR group.The parameters of time to peak (TTP), maximum signal enhancement ratio (SERmax ),positive enhancement integral (PEI),SER70 and SER84 at point 1 were higher than those at point 2,and there were significant differences between two groups (P <0.05).The values of SERmax ,SER42 ,SER56 ,SER70 and SER84 before treatment were higher in CR group than those in PR group,exhibiting significant differences between two groups (P <0.05).ROC curve analysis showed the threshold for SER56 was set to ≥129.4％ to predict complete remission,and the sensitivity and specificity were 60％ and 86.4％,respectively.Comparison of remission rates among different types of TIC showed complete remission rates in typeⅠTIC and type Ⅲ TIC were 87.5％ and 39.3％,respectively,exhibiting a significant difference between two groups (P =0.041). Conclusion TIC types and semi-quantitative parameters of DCE-MRI can predict therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma,SER56 is the most important predictive semi-quantitative parameter,and prognosis is much better in typeⅠTIC than type Ⅲ TIC before treatment.
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Objective To analyze and summarize the CT features of medullary thyroid carcinoma (MTC).Methods 30 patients with MTC proved by surgery and pathology were scanned by CT.And the CT manifestations were analyzed retrospectively.Results In a total of 30 patients,a single lesion in 25 (83.3%)patients and multiple ones in 5 (16.7%)were found with irregular shape in 27 (90.0%),unclear border in 26 (86.7%),heterogenous enhancement with irregular internal hypodensity in 27 (90.0%),cal-cifications in 4 (13.3%)and invasion of trachea in 4 (13.3%).As for the 29 patients underwent the neck surgery ,26 (89.7%) were pathologically confirmed with lymph nodes metastasis.CT showed the metastatic lymph nodes with well-defined border in 1 2 (46.2%)and ill-defined one in 14 (53.8%),calcifications in 5 (19.2%)and heterogenous enhancement with irregular internal hy-podensity in all (100.0%).Conclusion CT features of MTC and metastatic lymph nodes appeared as heterogenous enhancement with irregular internal low attenuation area,which can improve the accuracy of preoperative diagnosis.
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Objective To build a RNA interference vector for PQ-loop repeat protein (LRP) gene,and to evaluate the effect of the vector on the expression of PQ-LRP gene in Microsporum canis.Methods The PUC-PLULT and PCB309-PLULT vectors were constructed sequentially by using Agrobacterium tumefaciens-mediated T-DNA insertional mutagenesis,adding multiple cloning sites,and introducing the hygromycin-resistance gene.Microsporum canis was transformed with the PCB309-PLULT vector followed by a series of passages and hygromycin selection.Real-time quantitative PCR was performed to measure the expression of PQ-LRP gene in Microsporum canis before and after transformation.Results The intermediate vectors PUC-PLUT and PUC-PLULT were constructed and identified by PCR and gene sequencing.The 8 825-bp interference vector PCB309-PLULT was successfully built and confirmed by enzyme digestion.The optimum concentration of hygromycin for screening for Microsporum canis transformants was determined as 300 mg/L.The mRNA expression level of PQ-LRP was decreased by 61％ in the transformants as compared with untransformed Microsporum canis (0.39 vs.1.00).Conclusion The constructed PCB309-PLULT interference vector can effectively inhibit the expression of PQ-LRP gene in Microsporum canis.
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Objective To investigate the safety and feasibility of electrocoagulation of gallbladder artery in laparoscopic cholecystectomy ( LC) . Methods A total of 376 patients with gallbladder benign diseases underwent LC in our hospital from May 2004 to September 2013.The gallbladder artery was treated by electrocoagulation . Results Because of unclear gallbladder triangle due to abdominal adhesion , conversion to laparotomy was performed in 9 patients.In the remaining 367 patients, three-port LC with electrocoagulation of the gallbladder artery was conducted successfully .Laparoscopic appendectomy was conducted simultaneously in 12 patients.An additional fenestration and drainage of the left renal cyst was performed in 1 patient.Postoperatively, a secondary bile duct exploration was conducted in 1 patient because of bile duct obstruction caused by common bile duct stones . Conclusion The electrocoagulation of gallbladder artery is safe and feasible in LC for the treatment of gallbladder benign diseases .
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Objective To study the DCE-MRI findings of laryngeal and hypopharyngeal carcinoma.Methods 26 new patients di-agnosed laryngeal and hypopharyngeal cancer by pathology were collected and took DCE-MRI before therapy.The TIC type,ADC value,peak time (Tpeak),peak signal enhancement percentage (SERmax),positive enhancement integral(PEI),maximum slope of increase(MSI)and maximum slope of decrease(MSD)were obtained respectively.These semi-quantitative parameters of primary cancer,normal pharyngeal tissue and the same layer neck muscles were compared and P 0.05 )was found.Different b values (b = 300 s/mm2 , 500 s/mm2 )for ADC values were significantly different.There was statistical significance in semi-parameters among the primary cancer,normal pharyngeal wall tissue and the same layer neck muscles.Setting MSI value 58.32 threshold to distinguish abnormal and normal tissues,sensitivity and specificity both were 84.6%.Conclusion DCE-MRI can reflect morphology and signal differences among neck muscles,normal and abnormal laryngeal and hypopharyngeal tissues,providing help for diagnosis of primary carcino-ma.
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<p><b>BACKGROUND</b>Drug-eluting stents (DES) with durable polymer have significantly reduced restenosis and target vessel revascularization compared with bare metal stents. Durable polymer has been linked with persistent inflammation of vessel wall and delayed endothelial healing that may increase the risk of late and very late stent thrombosis. This study sought to evaluate the efficacy and safety of HELIOS completed biodegradable polymer sirolimus-eluting stent (SES) in de novo coronary lesions.</p><p><b>METHODS</b>Totally, 287 patients with one or two de novo coronary lesions (lesion length ≤ 38 mm and reference vessel diameter 2.5-4.0 mm) were enrolled in the HOPE study, a prospective, multicenter, randomized, non-inferiority trial. Patients were randomized to treatment either with HELIOS completed biodegradable polymer SES (n = 142) or PARTNER durable polymer SES (n = 145). The primary endpoint was angiographic in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint included stent thrombosis and major adverse cardiac events including cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR).</p><p><b>RESULTS</b>The 9-month in-stent LLL in the HELIOS group was similar to the PARTNER group, (0.16 ± 0.22) mm vs. (0.19 ± 0.30) mm (P = 0.28). The difference and 95% confidence interval were -0.03 (-0.09, 0.04), and the P value for non-inferiority <0.01. Major adverse cardiovascular event (MACE) occurred in 7.9% vs. 8.2%, MI in 2.4% vs. 3.0%, TLR in 5.5% vs. 3.0%, and stent thrombosis in 0 vs. 1.5%; and events were comparable between the HELIOS group and PARTNER group at three-year follow-up (all P > 0.05). The three-year cardiac death was lower in the HELIOS group, but with no significant difference, 0 vs. 3.0% (P = 0.12).</p><p><b>CONCLUSIONS</b>In the HOPE trial, the novel completed biodegradable polymer SES HELIOS was non-inferior to the durable polymer SES PARTNER with respect to nine-month in-stent LLL in de novo coronary lesions. The incidence of other clinical endpoints was low for both of the stents in three-year follow-up.</p>
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Adult , Aged , Humans , Middle Aged , Young Adult , Angiography , Coronary Artery Disease , General Surgery , Coronary Restenosis , Drug-Eluting Stents , Percutaneous Coronary Intervention , Polymers , Chemistry , Therapeutic Uses , Sirolimus , Therapeutic Uses , Titanium , Chemistry , Treatment OutcomeABSTRACT
Objective To compare the differential expression of MRP1 in human breast cancer sensitive cells (MCF-7/S)and resistant cells (MCF-7/TAM、MCF-7/ADR), and to preliminary distinguish whether there is a common mechanism between breast cancer cells resistant to tamoxifen (TAM) and to adriamycin(ADR).Methods We detected the expression of MRP1 gene and MRP1 protein in the three breast cancer cells by using the methods of real-time fluorescence quantitative PCR, and Western blot respectively.Results The expression of MRP1 gene in MCF-7/TAM and MCF-7/ADR cells was (2.63 ± 0.18) and (8.38 ±0.76) times of MCF-7/S cells respectively, which was significantly different (P1=0.004,P2=0.003). The expression of MRP1 protein in MCF-7/TAM and MCF-7/ADR cells was higher than MCF-7/S cells,which was consistent with the trend of MRP1 gene. Conclusions The high expression of MRP1 may be the common mechanism in breast cancer cells resistant to TAM and ADR.
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Objective To investigate the effects of Compound E-Jiao Slurry (CEJS) and Cyclophosphamide (CTX) on the inhibition of Lewis pulmonary carcinoma xenografts. Methods Tumor xenografts models were prepared and randomly divided into six groups by weight, including the control group,CTX, CEJS with the dosages of high, middle and low, with a total of ten mice in each group. The control mice were given normal saline 0.4ml by intragastric administration once daily, with a total of twelve times; The mice of CTX group were given CTX 0.2 ml by intraperitoneal injection every other day, with a total of six times; The mice of CEJS group were given CEJS 0.2 ml and saline 0.2 ml by intragastric administration; The mice of combination therapy group 1 were given CEJS 0.4 ml by intragastric administration once daily, and CTX 0.2 ml by intraperitoneal injection every other day; The mice of combination therapy group 2 were given CEJS 0.2 ml by intragastric administration once daily, and CTX 0.2 ml by intraperitoneal injection every other day; The mice of combination therapy group 3 were given CEJS 0.1 ml by intragastric administration once daily, and CTX 0.2 ml by intraperitoneal injection every other day. The weight of tumor xenografts were measured in the experiment,the inhibition rate of tumor xenografts were calculated according to the data after the dissection. Results The combination groups and CTX alone have an inhibition rate of over 50%, and the CEJS group 25.88%. In every experimental group, the weight of tumor showed statistical significance compared with the control (P0.05). Conclusion CEJS can't obviously enhance the sensitivity of tumor xenografts to CTX, but there is a trend for tumor inhibition.
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Objective To observe the effects of CEJS combined with chemotherapy on the expression of VEGF in lewis lung carcinoma.Methods Tumor xenografts models were set up and randomly divided into five groups including control group,CTX CEJS,high-dose CEJS joint CTX(combination group 1),and middle-dose CEJS joint CTX(combination group 2).Paraffin imbedding and HE staining were performed,and the tissue Shape was observed by microscope after section.The expressions of VEGF in five groups were determined by immuno-histochemistry.Results The expression level of VEGF could be significantly down-regulated in CTX or combination group 1 and 2,compared with the control group(P＜0.05):CEJS group had no significant difference to the control group(P＞0.05);The average optical density in the combination group 1 and 2 showed no significantly difference to the CTX group(P＞0.05).Conclusion The inhibition of CEJS could not down regulate of the expression of VEGF,but CEJS could keep the affection of chemotherapy drugs on VEGF.
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Gastric cancer is the fourth most common cancer and is the second leading cause of cancer death worldwide. Gastric cancer is usually in advanced stage at diagnosis, without opportunity for curative resection. Chemotherapy is the major treatment for advanced gastric cancer (AGC), and other treatments include palliative surgery, radiotherapy, chemotherapy, biologic and immunologic therapy as well as Chinese medicine. Palliative therapy is used to reduce tumor load or complication occurrence, while radiotherapy is effective for locoregionally advanced gastdc cancer. At present, chemotherapy plays a leading role in AGC treatment and has a palliative effect on symptomatic patients. For advanced or metastatic gastric cancer, chemotherapy has always been the focus of studies. Results of studies of FAX, ECF/DCF regimens and Phrase ill clinical trials of REAL-2, ML17032 and SPIRITS have been released. With the application of EOX, XP, S-1/CDDP, IF, FOLFOX and XELOX regimens, the outcomes of advanced gastdc cancer are improved. However, there is no standard regimen accepted as supedor over others. Biologic and immunologic therapy are beneficial supplements to surgery, chemotherapy and radiotherapy, but are not yet the mainstream. All of these treatments have obvious side effects. Other comprehensive methods are of equal importance, such as Chinese herbal medicine, acupuncture and moxibustion, and psychological intervention. Combined with western medicine, the above methods have certain merits in relieving clinical symptoms, reducing toxicity,increasing effectiveness, improving quality of life, preventing metastasis and recurrence, reversing multidrug resistance of tumor cells, and curing ascites and managing cancer pain.
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This text is based on the analysis of the arteries that reported in the literatures over the past 10 years and combines with the chinese medicine practice of theory and clinical. It researches the etiology and pathogenesis of chronic aplastic anemia and the chinese medicine therapy from the kidney, and comes up with the treatment countermeasure of nourishing the kidney and marrow and invigorating the blood, then we formulate a proprietary named Bushenyisui Huoxuefang.
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To investigate the effects of Compound Zhebei Granule (CZBG), a compound traditional Chinese herbal medicine, combined with adriamycin (ADM) on mdr 1 gene expression in tumor xenografts in nude mice.
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Blood hypercoagulabale state of malignant tumor was the pathological basis of tumor blood stagnation,which led to tumor proliferation and metastasis and also influenced the therapeutic effect and prognosis of tumor.Based on knowledge of thrombin and tissue factor system,We discussed the mechanism blood hypercoagulabale leading to tumor proliferation and metastasis,and the influence of traditional Chinese drugs of activating blood circulation to dissipate blood smsis on tunlor proliferation and metastasis.We concluded that traditional Chinese drugs have sound effects on prevention and treatment of tumor proliferation and metastasis.
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Objective To explore the syndrome distribution laws of refractory idiopathic thrombocytopenic purpura (RITP), and the relevance between various syndromes and gender, age, laboratory indicators, to reveal the essence of TCM syndrome and provide a reasonable and standard TCM treatment principle. Methods TCM syndrome, gender, age and laboratory indicators of 75 cases of RITP were studied retrospectively and analized statistically. Results Qi deficiency and blood stasis is the major syndrome, and Yin deficiency is the secondary syndrome. Compare with others, the patients with qi deficiency and blood stasis syndrome were older, and had longer disease courses and more severe conditions. Conclusion One of TCM intervention treatment principles for RITP is invigorating qi and yin, promoting blood circulation and removing blood stasis.
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Objective To translate the findings from fundamental research into clinical application and to evaluate the clinical efficiency and safety of Fritillaria thunbergii Miq. granule as adjunctive means of chemotherapy during peri chemotherapy of refractory acute leukemia. Methods Patients in multiple hospitals were randomly divided into two groups with Fritillaria thunbergii Miq. granule treatment or synchronous control at three days before chemotherapy respectively, according to random approaches for medical treatment. The clinical therapeutic effects were then determined after one course of treatment. Results According to the research project, 138 patients were analyzed statistically, 72 in Fritillaria thunbergii Miq. granule group and 66 in control group. The complete remission rate (CR) of Fritillaria thunbergii Miq. granule group and control group were 36.8% and 25.8% respectively, while the total effects were 77.8% and 53.0%, which was significantly different (P
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Objective To study the impact of compound zhe-bei granule and adriamycin on p53 gene expression in the P388 xenograft tumor.Methods The tumor xenografts model was established by injecting the mouse lymphocytic leukemia cells(P388) in the subcutis of anterior axillary of Kunming mice,and then was treated with CZBG by intragastric administration and different doses of adriamycin by intraperitoneal injection(i.p.).After the end of the experiment,tumor was striped completely,and the expression of p53 gene in xenograft tumor of each group was detected by fluorescence quantitative polymerase chain reaction,and the relative quantification of p53 gene of each group was computed using 2-??Ct method.Results Comparing the 2-??Ct values of p53 gene relative expression of each group,no statistical significance was found(F=0.56,P=0.7557).And the relative expression value of p53 gene of CZBG joint high-dose ADM group was higher,while the relative expression value of CZBG joint low-dose ADM group was lower.Conclusion Combined use of CZBG and ADM is able to raise the expression of p53 tumor suppressor gene in the P388 xenograft tumor.