Prevention of dexmedetomidine on postoperative delirium and early postoperative cognitive dysfunction in elderly patients undergoing hepatic lobectomy / 中南大学学报(医学版)

OBJECTIVES@#Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common operative neurocognitive disorders, which places a heavy burden on patients, families and society. Therefore, it is very important to search for preventive drugs. Previous studies have demonstrated that perioperative use of dexmedetomidine resulted in a decrease the incidence of POD and POCD. But the specific effect of dexmedetomidine on elderly patients undergoing hepatic lobectomy and its potential mechanism are not clear. This study aims to evaluate the efficacy of intraoperative use of dexmedetomidine on preventing POD and POCD in elderly patients undergoing hepatic lobectomy and the influence on the balance between proinflammation and anti-inflammation.@*METHODS@#This trial was designed as a single-center, prospective, randomized, controlled study. One hundred and twenty hospitalized patients from January 2019 to December 2020, aged 60-80 years old with American Society of Anesthesiologists (ASA) II-III and scheduled for hepatic lobectomy, were randomly allocated into 3 groups (n=40) using a random number table: A C group, a Dex1 group, and a Dex2 group. After anesthesia induction, saline in the C group, dexmedetomidine [0.3 μg/(kg·h)] in the Dex1 group, and dexmedetomidine [0.6 μg/(kg·h)] in the Dex2 group were infused until the end of operation. The incidences of hypotension and bradycardia were compared among the 3 groups. Confusion Assessment Method (CAM) for assessing POD and Mini Mental State Examination (MMSE) for evaluating POCD were recorded and venous blood samples were obtained for the determination of neuron specific enolase (NSE), TNF-α, IL-1β, and IL-10 at the different time below: the time before anesthesia (T0), and the first day (T1), the third day (T2), the fifth day (T3), and the seventh day (T4) after operation.@*RESULTS@#Compared with the C group, the incidences of bradycardia in the Dex1 group or the Dex2 group increased (both P<0.05) and there was no difference in hypotension in the Dex1 group or the Dex2 group (both P>0.05). The incidences of POD in the C group, the Dex1 group, and the Dex2 group were 22.5%, 5.0%, and 7.5%, respectively. The incidences of POD in the Dex1 group or the Dex2 group declined significantly as compared to the C group (both P<0.05). However, there is no difference in the incidence of POD between the Dex1 group and the Dex2 group (P>0.05). The incidences of POCD in the C group, the Dex1 group, and the Dex2 group were 30.0%, 12.5%, and 10.0%, respectively. The incidences of POCD in the Dex1 group and the Dex2 group declined significantly as compared to the C group (both P<0.05). And no obvious difference was seen in the incidence of POCD in the Dex1 group and the Dex2 group (P>0.05). Compared with the C group, the level of TNF-α and IL-1β decreased and the level of IL-10 increased at each time points (from T1 to T4) in the Dex1 group and the Dex2 group (all P<0.05). Compared with the Dex1 group, the level of IL-1β at T2 and IL-10 from T1 to T3 elevated in the Dex2 group (all P<0.05). Compared with the T0, the concentrations of NSE in C group at each time points (from T1 to T4) and in the Dex1 group and the Dex2 group from T1 to T3 increased (all P<0.05). Compared with the C group, the level of NSE decreased from T1 to T4 in the Dex1 group and the Dex2 group (all P<0.05).@*CONCLUSIONS@#Intraoperative dexmedetomidine infusion can reduce the incidence of POCD and POD in elderly patients undergoing hepatic lobectomy, and the protective mechanism appears to involve the down-regulation of TNF-α and IL-1β and upregulation of IL-10 expression, which lead to rebalance between proinflammation and anti-inflammation.

Prediction model of perioperative risk of deep venous thrombosis in patients with acute multiple knee joint injuries based on Logistic regression and XGBoost algorithm / 国际外科学杂志

Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of perioperative risk of deep venous thrombosis in patients with acute multiple knee joint injuries was constructed, and the prediction performance was compared.Methods:A total of 120 patients with acute multiple injuries around the knee treated in the Department of Orthopaedic Trauma, Guangzhou Panyu District Central Hospital from January 2017 to June 2020 were retrospectively selected. According to the proportion of 7∶3, the patients were randomly divided into training set ( n=84) and test set ( n=36). The prediction models of Logistic regression and XGBoost algorithm were constructed by training set data, to screen the predictors of perioperative deep venous thrombosis in patients with acute multiple injury around knee joint, and the prediction effect of the model was evaluated by test set data. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the independent t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)], the independent sample Mann-Whitney U test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Results:The results of Logistic regression model showed that age, hypertension, coronary heart disease, time from injury to operation, D-dimer at 1 day after operation and multiple injuries were predictive factors for perioperative deep venous thrombosis in patients with acute multiple injuries around the knee joint. The top five important feature scores of XGBoost algorithm model were combined multiple injuries (35 points), time from injury to operation (28 points), age (24 points), coronary heart disease (21 points) and D-dimer 1 day after operation (16 points). In the training set, the area under the curve of the Logistic regression model was 0.805 (95% CI: 0.637-0.912), and χ2=1.436, P=0.329 for Hosmer and Lemeshow test. The area under the curve of the XGBoost algorithm model was 0.847(95% CI: 0.651-0.920), and χ2=1.103, P=0.976 for Hosmer and Lemeshow test. Conclusion:Logistic regression model and XGBoost algorithm model are similar in predicting perioperative deep venous thrombosis in patients with acute multiple injuries around the knee, and multiple injuries, time from injury to operation, age, coronary heart disease and D-dimer 1 day after operation can be used as predictive factors.

1.5 T Nuclear Magnetic Resonance Imaging System Failure Treatment and Rectification Summary / 中国医疗器械杂志

Quench of magnetic resonance imaging system refers to the process that the superconducting condition inside the magnet is destroyed due to some reason. The large current stored in the coil is quickly converted into heat at the place where the resistance is formed, and a large amount of liquid helium in the magnet is evaporated. If it happens, it will cause huge loss to the user. We introduce the real cases of 1.5 T magnetic resonance imaging system's quench fault, maintenance treatment and management improvement, which can be used for reference by various medical institutions, so as to better strengthen the operation and maintenance management of magnetic resonance imaging system, so as to avoid the occurrence of out of tolerance fault, and do a good job in the guarantee work after the out of tolerance fault.

Clinical analysis of 17 cases of Kala-azar in Yangquan City, Shanxi Province / 中华地方病学杂志

Objective:To explore the epidemic characteristics, clinical features and therapeutic effects of Kala-azar in Yangquan City, Shanxi Province in recent years, and to improve the cognition of Kala-azar.Methods:The clinical data of 17 adult cases of Kala-azar in Yangquan City, Shanxi Province in 2018 and 2019 were collected by retrospective analysis method, the epidemiological characteristics, clinical diagnosis and first diagnosis, clinical manifestations, laboratory and imaging examination, treatment and prognosis of the patients were sorted and analyzed.Results:All 17 patients were from Yangquan City, Shanxi Province, including 15 males and 2 females. The main clinical manifestations were long-term irregular fever (17 cases), anemia (13 cases) and splenomegaly (16 cases). The main manifestations of blood routine included decreased white blood cell count (14 cases), anemia (13 cases), and decreased platelet count (10 cases). The positive rate of rk39 immunochromatographic strip test was 100.00% (14/14). Nine patients underwent bone marrow puncture smear examination, 7 patients were positive for Leishman-Donovan bodies. All patients were treated with sodium pentavalent antimony gluconate (hereinafter referred to as antimonials) for 10 days, the cure rate was 88.24% (15/17), and recurrence rate was 11.76% (2/17).Conclusions:The clinical manifestations of Kala-azar are not typical, and it is easy to be misdiagnosed. Early examination of bone marrow puncture smear and serum antibody should be carried out for suspected patients. Antimonials is still a safe and effective drug for treating Kala-azar.

Effect of continuous improvement of chest pain center on reperfusion and prognosis in patients with acute ST segment elevation myocardial infarction / 中国综合临床

Objective:To explore the effect of continuous improvement of emergency procedures in different departments on reperfusion and prognosis of patients with acute ST segment elevation myocardial infarction after chest pain center certification.Methods:From March 2018 to July 2019, the clinical data of 206 patients with acute ST segment elevation myocardial infarction and percutaneous coronary intervention diagnosed in the chest pain center of the Third Affiliated Hospital of Anhui Medical University&Hefei First People′s Hospital were analyzed retrospectively.Ninety-eight patients admitted before certification were set as the control group, and 108 patients admitted after certification were set as the study group.The patients in the study group and the experimental group were compared in terms of the time from the onset to the initial medical contact, the time from the entrance to the implantation of balloon dilation, the time from the initial medical contact to the implantation of balloon dilation, the time of total ischemia and the incidence of major cardiovascular adverse events 30 days after percutaneous coronary intervention.Logistic regression analysis was used to analyze the influencing factors of major adverse cardiovascular events 30 days after operation.Results:Compared with the control group, the time from initial medical contact to implantation of balloon was (84.5 (73.0, 96.0) min), the time of total ischemia was (205.0(159.8, 307.0) min), the time from entrance to implantation of balloon was (72.5(58.3, 83.8) min) in the study group, which was (112.0(93.0, 132.5) min, 241.0(199.0, 329.0) min, 78.0(68.0, 96.5) min was significantly shorter than that of the control group, and the difference was statistically significant (all P<0.05). The time from the onset of disease to the initial medical contact in the study group was slightly shorter than that in the control group(124.5 (77.3, 201.0) min and 130.0 (76.3, 216.0) min), there was no significant difference ( P>0.05). Compared with the control group, the incidence of major cardiovascular adverse events in the study group was lower 30 days after operation (16.7%(18/108) and 28.6%(28/98)), the difference was statistically significant( P=0.040). According to the results of multivariate logistic regression analysis, Killip Ⅲ, Ⅳ ( OR 2.618, 95% CI1.244-5.509, P=0.011), the time from onset to initial medical contact>90 min ( OR 4.562, 95% CI 2.167-9.603, P<0.001), the time from entrance to implantation of balloon>60 min ( OR 2.227, 95% CI1.087-4.563, P=0.029) was an independent risk factor for major adverse cardiovascular events 30 days after operation. Conclusion:The continuous improvement of chest pain center process can promote the rational utilization of medical resources in the region, more effectively shorten the treatment time of myocardial infarction patients, and reduce the occurrence of major cardiovascular adverse events within 30 days after operation.

Effects of different doses of atorvastatin combined with valsartan on blood pressure variability and circadian rhythm in patients with hypertension / 中国医师进修杂志

Objective:To study the effects of different doses of atorvastatin combined with valsartan on blood pressure variability (BPV) and circadian rhythm in patients with hypertension.Methods:Eighty patients with grade 2 and grade 3 hypertension from March 2018 to March 2019 in Hefei First People′s Hospital were divided into low-dose group (20 mg/d atorvastatin combined with valsartan) and high-dose group (40 mg/d atorvastatin combined with valsartan) according to the random number table method. The efficacy after 8 weeks of treatment was compared between the two groups. The BPV, circadian rhythm, vascular endothelial factors [nitric oxide (NO), endothelin (ET)], serum disease-related factors [human cartilage glycoprotein (YKL-40), soluble intercellular adhesion molecule-1(sICAM-1), folate] and blood lipids [total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] were recorded before treatment and 8 weeks after treatment, and the occurrence of adverse reactions during medicine was counted in the two group.Results:After 8 weeks of treatment, the total effective rate was 97.50%(39/40) in low-dose group and was 92.50%(37/40) in high-dose group, and there was no significant difference in the total effective rate between the two groups ( P>0.05). After 8 weeks of treatment, the 24 h SBPV, daytime SBPV, nighttime SBPV, 24 h DBPV, daytime DBPV and circadian rhythm in the two groups were significantly decreased compared with those before treatment, and the 24 h SBPV, daytime SBPV, daytime DBPV and circadian rhythm in high-dose group were significantly lower than those in low-dose group: (9.53 ± 1.73)% vs. (10.89 ± 1.98)%, (9.14 ± 1.90)% vs. (10.33 ± 2.07)%, (11.56 ± 2.78)% vs. (13.06 ± 3.16)%, (4.78 ± 1.56)% vs. (5.70 ± 1.81)%( P<0.05). After 8 weeks of treatment, the levels of NO, folate and HDL-C in the two groups were significantly increased compared with those before treatment, and the levels with in high-dose group were significantly higher than those in low-dose group: (67.16 ± 13.14) μmol/L vs.(60.53 ± 12.50) μmol/L, (14.94 ± 2.07) mmol/L vs.(13.83 ± 2.28) mmol/L, (1.42 ± 0.15) mmol/L vs. (1.31 ± 0.18)mmol/L ( P<0.05). The levels of ET, YKL-40, sICAM-1, TC, TG and LDL-C in the two groups were significantly decreased compared with those before treatment, and the levels in high-dose group were significantly lower than those in low-dose group: (33.63 ± 5.15) ng/L vs. (37.44 ± 5.13) ng/L, (32.68 ± 6.16) μg/L vs. (36.94 ± 6.03) μg/L, (203.78 ± 41.19) ng/L vs. (249.93 ± 50.81) ng/L, (6.78 ± 1.03) mmol/L vs. (7.38 ± 1.30) mmol/L, (2.88 ± 0.61) mmol/L vs. (3.39 ± 0.85) mmol/L, (3.14 ± 1.05) mmol/L vs. (3.85 ± 1.44) mmol/L ( P<0.05). Conclusions:Different doses of atorvastatin combined with valsartan are effective in the treatment of hypertension, but high dose of atorvastatin combined with valsartan has better effects on blood pressure variability and circadian rhythm, and can effectively improve vascular endothelial function.

Discussion on the indications of internal mammary sentinel lymph node biopsy in breast cancer in the era of precision medicine / 中华肿瘤杂志

Objective@#To determine the clinical benefits of internal mammary sentinel lymph node biopsy (IM-SLNB) acquired by breast cancer patients with clinically positive axillary lymph node (ALN), and further optimize the IM-SLNB indications.@*Methods@#All primary breast cancer patients with clinically positive ALN from February 2014 to September 2017 were prospectively recruited in this study. IM-SLNB was performed under the guidance of the modified injection technique. The success rate and visualization rate of IM-SLNB, metastatic rate of internal mammary sentinel lymph node (IMSLN) and its related factors were analyzed, and the clinical benefits were accessed according to the current guidelines.@*Results@#Among 126 patients, all of 94 patients (74.6%) who showed internal mammary drainage successfully underwent IM-SLNB. The incidence of internal mammary artery bleeding and pleural lesion were 4.3%(4/94) and 9.6%(9/94), respectively. The metastatic rate of IMSLN was 38.3% (36/94), which was significantly associated with the number of positive ALN (P<0.001) and tumor size (P=0.024). The lymph node staging of 94 patients who underwent IM-SLNB was more accurate. Among them, 36 cases with positive IMSLN underwent internal mammary radiotherapy (IMRT), while the other 58 cases with negative IMSLN avoided radiotherapy.@*Conclusions@#IM-SLNB should be routinely performed in patients with positive ALN. IM-SLNB can provide more accurate staging and guide tailored IMRT to benefit more breast cancer patients.

Therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures / 中国基层医药

Objective@#To explore the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF).@*Methods@#A retrospective analysis of 76 patients with OVCF treated with single and double pedicle approach PVP from April 2016 to June 2017 in the First Affiliated Hospital of He′nan University was conducted.According to the operation method, the patients were divided into unilateral group (42 patients, unilateral pedicle approach), and bilateral group (34 cases, bilateral pedicle approach). The operation time, number of intraoperative X-rays, amount of bone cement injection, height of the vertebral body and the complications were compared between the two groups.The visual analogue scale (VAS) and the Oswestry dysfunction index(ODI) score were used to assess the recovery of the patients.@*Results@#The unilateral group had less operative time[(33.01±3.78)min], intraoperative X-ray number[(22.06±3.85) times]and bone cement injection[(3.53±0.42) mL] compared with the bilateral group (t=8.54, 5.98, 4.74, all P<0.05). There were no statistically significant differences in the recovery of vertebral height and complications between the two groups (all P>0.05). The postoperative VAS and ODI of the two groups were significantly improved compared with those before operation (all P<0.05).@*Conclusion@#In the case of reasonable indications, the unilateral approach PVP is better than bilateral, and unilateral approach PVP should be the first choice for OVCF.

Expression of neuronal migration-related factors and the spatial learning and memory of rats prenatally exposed to tritiated water / 中华放射医学与防护杂志

Objective@#To study the expression of neuronal migration-related factors and spatial learning and memory of rats exposed to tritiated water (HTO).@*Methods@#Hippocampal neural cells from newborn Sprague-Dawley(SD) rats at postnatal 24 h were primarily cultured in DMEM/F12 medium with 20% of fetal bovine serum for 6 days, followed by subjection to tritiated water(HTO) at concentrations of 3.7×102, 3.7×103, 3.7×104, 3.7×105, 3.7×106 Bq/ml for 24 h, respectively. Western blot and RT-qPCR were used to determine the expression levels of F-actin, α-tubulin, tau, AP2, BDNF mRNA and Reelin mRNA. 16 pregnant SD rats at embryonic (E) day 14 were randomly divided into the tested and control groups (8 rats/ each group). The tested rats were injected with body fluid of HTO (3.7×106 Bq/g) intraperitoneally, while the saline as the control. Morris water maze (MWM) was employed for the spatial learning and memory of rats.@*Results@#Compared to the control cells, HTO caused a significant downregulation of expressions of cytoskeletal proteins [F-actin (t=8.898-19.896, P<0.05), α-tubulin (t=3.261-7.900, P<0.05), tau (t=2.274-5.003, P<0.05), and MAP2 (t=2.274-5.003, P<0.05)] and mRNA of BDNF(t=3.580-19.792, P<0.05) and Reelin (t=3.240-39.692, P<0.05) in the tested neural cells in a dose-dependent manner. In addition, the escape latency of irradiated offsprings was significantly prolonged (t=-2.563, P<0.05), the time for offsprings to cross through target quadrant was markedly reduced (t=3.214, P<0.05), and the swimming time in the platform quadrant of irradiated offsprings were obviously shortened (t=3.874, P<0.05) in the MWM trial.@*Conclusions@#The results indicate that HTO irradiation in utero downregulates the expressions of neuron migration-related factors and induces brain dysfunction, which may shed a light on a mechanism of the radiation-induced brain impairment.

Expression of neuronal migration-related factors and the spatial learning and memory of rats prenatally exposed to tritiated water / 中华放射医学与防护杂志

Objective To study the expression of neuronal migration-related factors and spatial learning and memory of rats exposed to tritiated water (HTO).Methods Hippocampal neural cells from newborn Sprague-Dawley (SD) rats at postnatal 24 h were primarily cultured in DMEM/F12 medium with 20％ of fetal bovine serum for 6 days,followed by subjection to tritiated water (HTO) at concentrations of 3.7× 102,3.7×103,3.7 × 104,3.7 × 105,3.7× 106 Bq/ml for 24 h,respectively.Western blot and RT-qPCR were used to determine the expression levels of F-actin,α-tubulin,tau,AP2,BDNF mRNA and Reelin mRNA.16 pregnant SD rats at embryonic (E) day 14 were randomly divided into the tested and control groups (8 rats/ each group).The tested rats were injected with body fluid of HTO (3.7× 106 Bq/g) intraperitoneally,while the saline as the control.Morris water maze (MWM) was employed for the spatial learning and memory of rats.Results Compared to the control cells,HTO caused a significant downregulation of expressions of cytoskeletal proteins [F-actin (t =8.898-19.896,P＜ 0.05),α-tubulin (t=3.261-7.900,P＜0.05),tau (t=2.274-5.003,P＜0.05),and MAP2 (t=2.274-5.003,P＜0.05)] and mRNA of BDNF (t=3.580-19.792,P＜0.05) and Reelin (t=3.240-39.692,P＜0.05)in the tested neural cells in a dose-dependent manner.In addition,the escape latency of irradiated offsprings was significantly prolonged (t =-2.563,P＜0.05),the time for offsprings to cross through target quadrant was markedly reduced (t=3.214,P＜0.05),and the swimming time in the platform quadrant of irradiated offsprings were obviously shortened (t =3.874,P＜0.05) in the MWM trial.Conclusions The results indicate that HTO irradiation in utero downregulates the expressions of neuron migration-related factors and induces brain dysfunction,which may shed a light on a mechanism of the radiation-induced brain impairment.

Therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures / 中国基层医药

Objective To explore the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF).Methods A retrospective analysis of 76 patients with OVCF treated with single and double pedicle approach PVP from April 2016 to June 2017 in the First Affiliated Hospital of He'nan University was conducted.According to the operation method,the patients were divided into unilateral group (42 patients,unilateral pedicle approach),and bilateral group (34 cases,bilateral pedicle approach).The operation time,number of intraoperative X-rays,amount of bone cement injection,height of the vertebral body and the complications were compared between the two groups.The visual analogue scale (VAS) and the Oswestry dysfunction index(ODI) score were used to assess the recovery of the patients.Results The unilateral group had less operative time[(33.01 ± 3.78) min],intraoperative X-ray number [(22.06 ± 3.85) times] and bone cement injection [(3.53 ± 0.42) mL] compared with the bilateral group (t =8.54,5.98,4.74,all P ＜ 0.05).There were no statistically significant differences in the recovery of vertebral height and complications between the two groups (all P ＞ 0.05).The postoperative VAS and ODI of the two groups were significantly improved compared with those before operation (all P ＜ 0.05).Conclusion In the case of reasonable indications,the unilateral approach PVP is better than bilateral,and unilateral approach PVP should be the first choice for OVCF.

Murine Model Study of a New Receptor-Targeted Tracer for Sentinel Lymph Node in Breast Cancer / 한국유방암학회지

PURPOSE: Sentinel lymph node biopsy (SLNB), a critical staging and treatment step, has replaced axillary lymph node (LN) dissection as the standard staging procedure for early stage breast cancer patients with clinically negative axillary LNs. Hence, using a murine sentinel lymph node (SLN) model, we investigated the localization effect of the new receptor-targeted tracer, indocyanine green (ICG)-rituximab, on breast cancer SLNB. METHODS: After establishing the murine SLN model, different doses of ICG-rituximab were subcutaneously injected into the hind insteps of BALB/c mice to determine the optimal dose and imaging time using continuous (> 3 hours) MDM-I fluorescence vasculature imaging. To explore the capacity of ICG-rituximab for sustained SLN localization with the optimal dose, MDM-I imaging was monitored at 6, 12, and 24 hours. RESULTS: The popliteal LN was defined as the SLN for hindlimb lymphatic drainage, the iliac LN as the secondary, and the para-aortic or renal LN as the tertiary LNs. The SLN initial imaging and optimal imaging times were shortened with increased ICG-rituximab doses, and the imaging rates of the secondary and tertiary LNs increased accordingly. The optimal ICG dose was 0.12 μg, and its optimal imaging time was 34 minutes. After 24 hours, the SLN imaging rate remained 100%, while those of the secondary and the tertiary LNs increased from 0% (6 hours) and 0% (6 hours) to 10% (12 hours) and 10% (12 hours) to 20% (24 hours) and 10% (24 hours), respectively. CONCLUSION: ICG-rituximab localized to the SLN without imaging from the secondary or tertiary LNs within 6 hours. The optimal ICG dose was 0.12 μg, and the optimal interval for SLN detection was 34 minutes to 6 hours post-injection. This novel receptor-targeted tracer is of great value to clinical research and application.

Accuracy of high resolution MRI in measurement of vascular stenosis ratio in atherosclerotic middle cerebral artery / 中华全科医师杂志

Objective To evaluate the accuracy of measurements of atherosclerotic middle cerebral artery (MCA) stenosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI).Methods Forty patients with symptomatic atherosclerotic stenosis of middle cerebral artery (MCA) confirmed by digital subtraction angiography (DSA) in the Affiliated Hospital of Binzhou Medical College from September 2017 to May 2018 were enrolled in the study.Patients were scanned by HR-MRI sequence (including T1WI,T2WI,PDWI).The MCA M1 stenosis rate on HR-MR images was assessed by warfarin-aspirin symptomatic intracranial artery disease (WASID) method and area measurement algorithm,respectively,and based on the stenosis rate the degree of stenosis (semi-quantitative measurement) was determined.The accuracy of the two measurement methods was evaluated with DSA results as the gold standard.Results The HR-MRI images showed the structure of the vessel wall clearly in 30 patients meeting the measurement requirements.The inner edge of the vessel was clearly distinguishable and smooth,showing eccentric stenosis.The stenosis rate of MCA measured by DSA,WASID method and area measurement algorithm were (82± 17)％,(70± 12)％,(81 ± 16)％,respectively (P＞0.05).The result of area measurement algorithm was better correlated with DSA (r=0.893);and the coincidence of the stenosis degree rate of two measurement method was 90％(27/30).Conclusion The area measurement algorithm based on the HS-MRI has high accuracy in measuring the degree of MCA stenosis,which is of high clinical application value.

Internal Mammary Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer / 한국유방암학회지

PURPOSE: The definition of nodal pathologic complete response (pCR) after a neoadjuvant chemotherapy (NAC) just included the evaluation of axillary lymph node (ALN) without internal mammary lymph node. This study aimed to evaluate the feasibility of internal mammary-sentinel lymph node biopsy (IM-SLNB) in patients with breast cancer who underwent NAC. METHODS: From November 2011 to 2017, 179 patients with primary breast cancer who underwent operation after NAC were included in this study. All patients received radiotracer injection with modified injection technology. IM-SLNB would be performed on patients with internal mammary sentinel lymph node (IMSLN) visualization. RESULTS: Among the 158 patients with cN+ disease, the rate of nodal pCR was 36.1% (57/158). Among the 179 patients, the visualization rate of IMSLN was 31.8% (57/179) and was 12.3% (7/57) and 87.7% (50/57) among those with cN0 and cN+ disease, respectively. Furthermore, the detection rate of IMSLN was 31.3% (56/179). The success rate of IM-SLNB was 98.2% (56/57). The IMSLN metastasis rate was 7.1% (4/56), and all of them were accompanied by ALN metastasis. The number of positive ALNs in patients with IMSLN metastasis was 3, 6, 8, and 9. The pathology nodal stage had been changed from pN1/pN2 to pN3b. The pathology stage had been changed from IIA/IIIA to IIIC. CONCLUSION: Patients with visualization of IMSLN should perform IM-SLNB after NAC, especially for patients with cN+ disease, in order to complete lymph nodal staging. IM-SLNB could further improve the definition of nodal pCR and guide the internal mammary node irradiation.

Correlation between the heart rate deceleration capacity and the scope of coronary artery lesions in patients with unstable angina pectoris / 中国综合临床

Objective To investigate the changes of heart rate deceleration capacity(DC)in patients with unstable angina pectoris(UAP)and its correlation with the scope and severity of coronary artery disease. Methods From September 2016 to January 2017,one hundred and nine patients with UAP and 52 with non-coronary artery disease were diagnosed in the department of cardiology in the Third Affiliated Hospital of Anhui Medical University. They were all measured with 24h dynamic electrocardiogram and the corresponding analysis software was used to analyze the results,and the difference in deceleration capacity between the two groups was compared. The severity and the number of coronary artery lesions were compared with different deceleration capacity in UAP patients. The relationship between deceleration capacity and the number of coronary artery stenosis, the scope and severity of coronary artery lesions were then analyzed. Results The deceleration capacity value of UAP group was significantly lower than that of the control group((5.10 ± 1.34)vs.(6.03 ±1.40),t=-3.775,P<0.01). The number of coronary artery lesions and Gensini score in group deceleration capacity>4.5 ms were smaller than those in group deceleration capacity ≤4.5 ms((1.67± 0.77)branches vs. (26.76±25.31)branches;(21.27±5.541)points vs.(42.69±8.61)points)(t= -3.910,-2.277,P<0.05). The deceleration capacity value was negatively correlated with the number of coronary artery stenosis(r=-0.206,P<0.01)and the Gensini score(r=-0.358, P<0.01)in patients with UAP. Conclusion Deceleration capacity decreased in patients with UAP and it was closely associated with the severity and the scope of coronary artery lesions.

Effect of extract of selenium-enriched Astragalus membranaceus on insulin resistance in streptozotocin-induced diabetic rats / 中国药科大学学报

@#To explore the effects of extract of selenium-enriched Astragalus membranaceus(ESAM)on insulin resistance(IR)in streptozotocin(STZ)diabetic rats. In this study, type 2 diabetes mellitus(T2DM)was established; ESAM and pioglitazone were used to intervene T2DM model rats; the general condition of rats in each group was observed, and body weight and fasting blood glucose(FBG)were recorded before modeling and after modeling. At the end of the fourth week, the blood and liver tissues of each group were collected. The total cholesterol(CHOL), triglyceride(TG), high-density lipoprotein(HDL), low-density lipoprotein(LDL)in blood were detected by biochemical detector; ELISA was used to detected content changes of blood fasting insulin(FINS), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), C-reactive protein(CRP), interleukin-1β(IL-1β); Western blotting was used for the detection of insulin receptor substrate protein 1(IRS1), phosphorylated IRS1(p-IRS1), nuclear factor κB inhibitor kinase β(IKKβ), phosphorylated IKKβ(p-IKKβ), c -Jun N-terminal kinase(JNK), phosphorylated JNK(p-JNK)protein changes. Results showed that compared with the blank group, the body weight of the model group was significantly decreased. FBG, CHOL, TG, LDL, TNF-α, IL-6, CRP, IL-1β in the blood and p-IRS1, p-IKKβ, p-JNK in the liver was increased significantly; after intervention, pioglitazone, ESAM can reverse the body weight of the model rats and the changes of the above cytokines and proteins. In conclusion, ESAM can reduce the expression of inflammatory cytokines in T2DM rats, inhibit the increase of free fatty acids(FFA), decrease the activation of IKKβ and JNK phosphorylation in surrounding tissues, activate insulin pathway and improve the IR effect of T2DM.

FU Weimin's Experience in Treating Schizophrenia Through Accurate Differentiation / 浙江中医药大学学报

[Objective ]Summarizing the old Chinese medicine Professor FU Weimin's experience in diagnosis and treatment of schizophrenia. [ Methods ] Learning from Professor FU as well as collating his medical case of schizophrenia. [Results] Professor FU thinks that sputum fire blinded heart is the pathogenesis of schizophrenia, with the Qi stagnation and blood stasis as the main risk factors. Therefore, during the treatment, clear heat and resolve phlegm should be a fundamental, and with relieving the depressed liver, promoting blood circulation to remove stasis and purgation. He emphasizes the precise dialectical when talking about the disease stage. In aspect of the drug matching, Professor FU uses formulae to clear heat and resolve phlegm, regulate the Qi, treat the interior excess syndrome with purgation and open the orifices to solve the external and internal diseases. He prefers to protect the stomach and has already made a good therapeutic effect in clinical application. [Conclusion] Professor FU's experience in treating schizophrenia provides TCM ideas and methods for clinical practice, which is worthy of popularizing.

Molecular subtypes and axillary downstaging surgery after neoadjuvant chemothera-py for breast cancer / 中国肿瘤临床

Objective:To determine the optimal time to perform sentinel lymph node biopsy(SLNB)in patients with clinically node-negative disease and assess clinically node-positive patients who would acquire greater benefits from axillary downstaging surgery af-ter neoadjuvant chemotherapy(NAC).Methods:From October 2010 to November 2017,206 patients with breast cancer who under-went surgery after NAC were included in this retrospective study in Shandong Cancer Hospital Breast Cancer Center.Their clinicopatho-logic data were collected to discuss the correlation between axillary node pathologic complete response(apCR)and different molecu-lar subtypes.Results:Among 206 patients who received NAC,183 patients had clinically node-positive disease.The frequency of apCR after NAC was 33.3%(61/183),which was significantly higher in patients with human epidermal growth factor receptor 2(HER-2)-posi-tive subtype[with targeted therapy,62.1%(18/29);without targeted therapy,34.5%(10/29)]and triple-negative breast cancer(TNBC) (41.0%)(16/39)than in patients with HER-2-negative luminal subtype breast cancer[19.8%(17/86)](P<0.001). Among 23 patients with Cn0 tumors,the rate of positive sentinel lymph nodes after NAC was 26.1%(6/23);this rate was 36.4%(4/11),25.0%(1/4),and 12.5% (1/8)among patients with HER-2-negative luminal subtype breast cancer,TNBC,and HER-2-positive subtype breast cancer,respective-ly.Conclusions:Molecular subtypes could predict the chance of achieving apCR.For patients with clinically node-negative disease,it would be preferable to perform SLNB prior to NAC for patients with HER-2-negative luminal subtype breast cancer.SLNB after NAC for those with TNBC and HER-2-positive subtype breast cancer could decrease the chances of axillary lymph node dissection.For patients with initial clinically node-positive disease converting to clinically node-negative disease after NAC,especially in TNBC and HER-2-posi-tive subtype breast cancer,these patients might benefit more from axillary downstaging surgery after NAC.

Application of pathological three-dimensional reconstruction in margins assessment and radiotherapy adjustment of breast-conserving surgery / 国际肿瘤学杂志

Objective To reconstruct the original three-dimensional conformation of tumor resection tissue through the study of breast-conserving surgery excision specimens for part-mount sub-serial section and pathological three-dimensional (3D) reconstruction,to establish a new margin assessment model,and to guide tumor bed delineation individually for radiotherapy.Methods From February 2016 to February 2017,thirtythree eligible breast cancer patients underwent breast-conserving surgery in Breast Cancer Center of Shandong Cancer Hospital were recruited.The excision specimens were prepared with part-mount sub-serial section,and residual tumors were microscopically outlined,scanned and registered by Photoshop software.The 3D model of residual tumors was reconstructed with 3D-DOCTOR software to evaluate margin status and record pathological type,tumor length and 3D negative margin distance.The gross tumor volume (GTV) was delineated based on clips placed in the lumpectomy cavity.CTV1 and CTV2 were defined by adding uniform 1.00 cm and 1.50 cm margin based on GTV respectively.CTV3 and CTV4 were defined by adding 1.00 cm and 1.50 cm margin based on 3D boundary of excision tumor respectively,and compared the volume differences of CTV1 and CTV3,CTV2 and CTV4.Results Based on the marginal assessment results of 3D pathological reconstruction,the rates of false negatives during the intraoperative rapid pathological examination and postoperative routine pathological margin evaluation were 6.7％ (2/30) and 3.4％ (1/29) respectively.The pathological type of pathological large slice and routine pathological examination was consistent with rate of 93.9％ (31/33).The M(QR) tumor lengths of routine pathological and pathological 3D reconstruction were 1.90 (1.50-2.40) cm and 2.00 (1.60-2.70) cm respectively,with statistical difference between the two groups (Z =-2.438,P =0.015).The M(QR) volumes for CTV1,CTV2,CTV3,CTV4 were 70.76 (49.84-78.07)cm3,110.11 (83.38-126.17) cm3,23.85 (16.46-31.49)cm3 and 38.74 (30.47-50.58) cm3 respectively.There were statistical differences between CTV1 and CTV3,CTV2 and CTV4 (Z =-4.372,P ＜0.001;Z =-4.372,P ＜0.001).Conclusion The application of pathological 3D reconstruction technology can largely compensate for the shortcomings of the traditional margin assessment model,make the decisions of adjuvant treatment after breast-conserving surgery more accurate,and guide the tumor bed delineation individually for radiotherapy.

The clinical value of cystatin C,homocysteine and urinary alkaline phosphatase in the diagnosis of diabetic nephropathy / 国际检验医学杂志

Objective To study the clinical value of cystatin C,homocysteine and urinary alkaline phospha-tase in the diagnosis of diabetic nephropathy,and provide the basis for clinical diagnosis of diabetes mellitus. Methods 60 cases of simple diabetic patients who were treated in our hospital from January 2015 to December 2016 were selected as diabetes mellitus,selected 60 cases with diabetic nephropathy as diabetic nephropathy group,60 cases of healthy subjects in our hospital as the control group.The levels of cystatin C,homocysteine and urinary alkaline phosphatase and the positive rate of the three groups were observed and compared with those of the control group.Results The results of cystatin C,homocysteine and urinary alkaline phosphatase were significantly higher in diabetes mellitus group and diabetic nephropathy group than those in control group(P<0.05).The positive rate of cystatin C,homocysteine and urinary alkaline phosphatase in diabetic group and diabetic nephropathy group was higher than that in control group,the difference was statistically significant(P<0.05).Conclusion Serum cystatin C,homocysteine and urinary alkaline phosphatase can be used in the clinical diagnosis of diabetic nephropathy,and it is worthy to be popularized in clinical application.