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OBJECTIVE To study the clinical characteristics of leflunomide-induced int erstitial pneumonia （Lef-IP），and to provide reference for its clinical diagnosis ，treatment and prevention. METHODS Lef-IP cases published in domestic and foreign journals from January 2004 to June 2021 were collected. Relevant information of patients were extracted and analyzed retrospectively， including basic characteristics ，clinical manifestations ，imaging manifestations ，laboratory examinations ， histopathological examinations ，treatment and outcome. RESULTS A total of 54 Lef-IP patients from case reports of 24 publications were included ，with a median age of 61 years（9-83 years）. Pulmonary symptoms appeared from 3.3 weeks to 132.9 weeks（median time of 14.5 weeks）. Patients with a loading dose of leflunomide have a shorter median time to pulmonary symptoms appearing （7.5 weeks）. The main clinical manifestations were dyspnea （85.2％），cough（57.4％），fever（53.7％）. CT imaging examination showed 19 cases with ground-glass shadow in both lungs ，and 29 cases showed interstitial infiltration in both lungs on chest radiograph；blood gas analysis showed hypoxemia and hypocapnia ；the levels of C-reactive protein and Krebs von Den lungen- 6 （KL-6）increased；histopathological examination mainly showed interstitial pneumonia （8 cases），including 3 cases of diffuse alveolar injury ，4 cases of lymphocytes in bronchoalveolar lavage fluid ，and 1 case of noncaseating granuloma. After discontinued leflunomide and symptomatic treatment （antibiotics，hormones，colecenamine，plasma exchange ），35 patients（64.8％）recovered or improved their lung symptoms. Twelve patients （22.2％）died，and patients with fever may had a higher mortality rate （34.5％， P＝0.02）. CONCLUSIONS The main clinical manifestations of Lef-IP are dyspnea ，cough and fever. Loading doses of leflunomide should be avoided at the beginning of treatment. When lef-IP occurs ，leflunomide is discontinued and corresponding treatment is given，and most of the patients ’pulmonary symptoms can return to normal or be improved.
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Objective: To compare the effectiveness of modified transforaminal lumbar interbody fusion (modified-TLIF) and posterior lumbar interbody fusion (PLIF) for mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. Methods: The clinical data of 106 patients with mild to moderate lumbar spondylolisthesis (Meyerding classification≤Ⅱ degree) who met the selection criteria between January 2015 and January 2017 were retrospectively analysed. All patients were divided into modified-TLIF group (54 cases) and PLIF group (52 cases) according to the different surgical methods. There was no significant difference in preoperative clinical data of gender, age, disease duration, sliding vertebra, Meyerding grade, and slippage type between the two groups ( P>0.05). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, hospital stay, and complications of the two groups were recorded and compared. The improvement of pain and function were evaluated by the visual analogue scale (VAS) score and Japanese Orthopedic Association (JOA) score at preoperation, 1 week, and 1, 6, 12 months after operation, and last follow-up, respectively. The effect of slip correction was evaluated by slip angle and intervertebral altitude at preoperation and last follow-up, and the effectiveness of fusion was evaluated according to Suk criteria. Results: All patients were followed up, the modified-TLIF group was followed up 25-36 months (mean, 32.7 months), the PLIF group was followed up 24-38 months (mean, 33.3 months). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, and hospital stay of the modified-TLIF group were significantly less than those of the PLIF group ( P0.05). At last follow-up, the fusion rate of the modified-TLIF group and the PLIF group was 96.3% (52/54) and 98.1% (51/52), respectively, and no significant difference was found between the two groups ( χ2=0.000, P=1.000). About complications, there was no significant difference between the two groups in nerve injury on the opposite side within a week, incision infection, and pulmonary infection ( P>0.05). No case of nerve injury on the operation side within a week or dural laceration occurred in the modified-TLIF group, while 8 cases (15.4%, P=0.002) and 4 cases (7.7%, P=0.054) occurred in the PLIF group respectively. Conclusion: Modified-TLIF and PLIF are effective in the treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. However, modified-TLIF has relatively less trauma, lower blood loss, lower drainage volume, lower incidence of dural laceration and nerve injury, which promotes enhanced recovery after surgery.
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Objective To systematically evaluate the efficacy and safety of 125I seed implantation on the treatment of refractory thyroid carcinoma.Methods A total of 14 patients with refractory thyroid carcinoma received CT and ultrasound image-guided 125I seed implantation in our hospital from Apr.2003 to Oct.2016.The radioactive activity ranged from 0.3 to 0.8 mCi,and the prescribed doses were 80 to 120 Gy.11 patients were diagnosed as differentiated thyroid carcinoma and 3 patients were medullary thyroid carcinoma.The local control rate,pain relief and complications were observed.Results The patients were followed up from 12 to 96 months.Two months after treatment,complete remission happened in three patients,partial remission in nine,and disease stability in two,no patients with progression.The half year,one year,two year local control rate was 100％,92％ and 42％,respectively.Seven patients were evaluated using number rating scales and obtained a score of 4.14±1.68 before therapy.Two months after treatment,the score was reduced to 2.00±1.15 (P＜0.000).No usual complications occurred during or after treatment except for I acute skin radio reaction in 4 cases.Conclusion 125I seed interstitial implantation for refractory thyroid carcinoma under guidance of ultrasound or CT is efficient and safe.
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Objective To investigate the clinical application of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type. Methods According to the random table method, 93 vertebrobasilar artery insufficiency vertigo patients with stasis orifice type were divided into the control group (n=46) and the treatment group (n=47). The patients in the control group were treated with fluoguizine hydrochloride, while the patients in the treatment group were treated with Tongqiao-Huoxue decoction on the basis of control group. Two groups were treated for 4 weeks. The clinical total effective rate of two groups of patients after treatment was compared. The LVA mean blood flow velocity, RVA mean blood flow velocity, BA mean blood flow velocity, total blood viscosity, plasma viscosity, erythrocyte aggregation index, fibrinogen, TC, TG, LDL-C and HDL-C were detected respectively before and after treatment. In addition, the adverse reaction incidence of two groups of patients were observed. Results The total effective rate of treatment group was 93.6% (44/47), while the total effective rate of control group was 78.3% (36/46). The difference between two groups was statistically significant (χ2=4.559, P=0.033). After treatment,the LVA mean blood flow velocity (38.34 ± 3.72 cm/s vs. 29.73 ± 3.11 cm/s, t=12.096), RVA mean blood flow velocity (41.12 ± 4.05 cm/s vs. 34.11 ± 3.86 cm/s, t=8.541),BA mean blood flow velocity (48.92 ± 5.24 cm/s vs. 40.75 ± 4.63 cm/s, t=7.962), HDL-C (2.13 ± 0.64 mmol/L vs. 1.54 ± 0.53 mmol/L, t=4.836) of treatment group were significantly higher than the control group (P<0.05), while the total blood viscosity, plasma viscosity, erythrocyteaggregation index, fibrinogen, TC, TG, LDL-C of treatment group were significantly lower than the control group (t value were 5.457, 8.875, 3.661, 6.549, 3.838, 6.369, 5.201, all Ps<0.05). No serious adverse reactions occurred during the treatment of the two groups. Conclusions The clinical curative effect of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type is significantly, and it can increases blood flow to the brain, improve hemorheology and lipid levels. It has the high security of the forward curative effect.
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Objective To evaluate the effect of contrast medium on the renal function in patients with cerebrovascular disease accompanied by diabetes mellitus after receiving neuro - interventional therapy. Methods The clinical data of a total of 108 patients with cerebrovascular disease complicated by diabetes mellitus type 2, who were treated with neuro - interventional therapy during the period from March 2013 to March 2016, were retrospectively analyzed. The contrast dose used in interventional procedures was less than 250ml in each patient. The preoperative and 24 h -postoperative serum creatinine (sCr), serum cystatin C (Cys C) levels were determined, and based on the modification of dietary renal disease (MDRD) equation and Larsson equation the estimated glomerular filtration rates (eGFR) were separately calculated. Results Compared with preoperative values, the 24 h - postoperative mean sCr and Cys C levels were increased significantly (P=0. 001, P=0. 015 respectively), while the average eGFR rates were remarkably decreased (P＜ 0. 000 1 by using MDRD equation, and P=0. 021 by using Larsson equation). No kidney damage that needed to be treated occurred in all patients. Conclusion The contrast dose used in neuro - interventional procedures can cause decline of renal function in patients with type 2 diabetes mellitus. The combined determination of sCr and Cys C levels is helpful for the detection of contrast - induced changes in renal function as early as possible. The use of conventional dose of contrast agent in neuro - interventional procedures is safe for patients with type 2 diabetes mellitus. (J Intervent Radiol, 2018, 27:277-280)
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Objective To investigate the effectiveness and safety in patients with largeartery occlusive acute cerebral infarction who received multi-interventional modes mainly with mechanical thrombectomy and its related factors affecting prognosis. Methods The clinical data of 56 patients with large artery occlusive acute cerebral infarction were analyzed retrospectively. The clinical characteristics (gender,age,and underlying diseases),timing of treatment (time from ictus to puncture,time from puncture to recanalization), multi-interventional mode therapies (intra-arterial thrombolysis,thrombectomy,balloon dilation,and stenting, etc. ),and distribution of offending vessels were observed. The modified Thrombolysis in Cerebral Ischemia Scale (mTICI)grade was used to evaluate revascularization. The National Institute of Health Stroke Scale (NIHSS)score was used to observe the neurological function at 24 h before and after procedures. The modified Rankin scale (mRS)was used to evaluate the prognosis at 3 months after procedure. The safety of the treatment was evaluated with operative complications (mainly symptomatic intracranial hemorrhage)and mortality. The patients were divided into either a good prognosis group (n = 34;mRS≤2)or a poor prognosis group (n =22;mRS≥3)according to the prognosis at 3 months after procedure. They were analyzed with univariate analysis. The factors influencing the prognosis were further analyzed with multivariate logistic regression analysis. Results (1)The recanalization rate in 56 patients was 78. 6%(n = 44),in which basilar artery was the highest,reaching 93. 8% (15 / 16),middle cerebral artery was 87. 0% (20 / 23). The NIHSS score at 24 hours was 10 ± 7,it was lower than 16 ± 6 on admission. There was significant difference (t =6. 401,P <0. 01). At 3 months,34 patients (60. 7%)had good prognosis,4 (7. 1%)died,and 8 (14. 3%) had symptomatic intracranial hemorrhage. (2)Multiple factor analysis showed that the high level of recanalization was a protective factor for good prognosis (OR,0. 465,95% CI 0. 267 -0. 809,P =0. 007). Diabetes was an independent risk factor for poor prognosis (OR,5. 535,95% CI 1. 101 -27. 835, P = 0. 038). Conclusion Acute large artery occlusive cerebral infarction treated with the intra-arterial multi-interventional modes may quickly and effectively restore intracranial blood flow. It has the characteris-tics of high recanalization rate and good prognosis,and the higher the level of recanalization,the better the prognosis. Diabetes is an independent risk factor for poor prognosis.
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OBJECTIVE:To prepare Weiyoukang intragastric floating tablet,and to investigate in vitro releasing characteristics of it. METHODS:Weiyoukang intragastric floating tablet was prepared by full powder compression method using HPMC-K15M (framework material),octadecanol(low density bleaching promoter),sodium bicarbonate(foaming agent),PVP-K30(release reg-ulator)and magnesium stearate(lubricant)as excipients. The amounts of HPMC-K15M,octadecanol and PVP-K30 were optimized by orthogonal test and validated with 2 h,4 h and 8 h accumulative release rate of berberine (Y2 h,Y4 h,Y8 h) as index,start time (T1)and duration(T2)of floating as adjunctive index. The releasing regularity of berberine,tetrahydropalmatine,baicalin and glyc-yrrhizic acid in Coptis chinensis,Corydalis vanhus,Scatellaria baicalensis and Glycyrrhiza uralensis were measured by release model fitting method and Peppas equarion fitting method. Similar factor(f2)method was used to investigate the similarity of 4 com-ponents. RESULTS:The optimized formulation was as follows as HPMC-K15M 40 g,octadecanol 14 g,PVP-K30 2 g for 200 tab-lets. Y2 h,Y4 h and Y8 h of berberine of preparations were 31.94%,55.88%,93.34%(RSDs were 1.2%,1.5% and 1.5%,n=3),re-spectively. T1 and T2 were about 1 min and 13 h. The drug release of four ingredients all fitted Higuchi models,and were synergis-tic action of diffusion and matrix erode. The f2 were all more than 80,indicating that the release of four ingredients were similar. CONCLUSIONS:Weiyoukang intragastric floating tablet is prepared successfully,showing fast onset,long floating,sustained-re-lease and balanced release of multiple indigents.
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Objective To investigate the correlation between different blood pressure levels and carotid atherosclerotic plaque formation.Methods The population participated in stroke screening were selected from September 2012 to January 2013 in Dongying,Shandong province.The subjects met the diagnostic criteria of ideal blood pressure (systolic blood pressure [SBP] ＜ 120 mm Hg and diastolic blood pressure [DBP] ＜80 mm Hg,1 mm Hg =0.133 kPa),normotensive (SBP 120-129 mm Hg and/or DBP 80-84 mm Hg),and high-normal blood pressure (SBP 130-139 mm Hgand/or DBP 85-89 mm Hg)were selected.The questionnaires,physical examinations,blood biochemical tests,and neck vascular ultrasound examination were performed.The detection rates of carotid plaque among the normotensive,high-normal blood pressure and ideal blood pressure groups were compared.Multivariatelogistic regression analysis was used to identify the independent risk factors for carotid plaque.Results The proportions of men and diabetes,as well as the levels of body mass index (BMI) and fasting blood glucose (FBG) of the normotensive and high-normal blood pressure groups were significantly higher than those of the ideal blood pressure group (all P ＜0.05).The detection rates of carotid plaque of the normotensive,high-normal blood pressure and ideal blood pressure groups were 12.41％,38.14％ and 49.45％,respectively.The proportions of men and age,as well as the levels of SBP,FBG,and homocysteine (Hcy) of the carotid plaque formation group were significant higher than those of the non-carotid plaque formation group (all P ＜0.05).Multivariable logistic regression showed that age,SBP,FBG,and Hcy were the independent risk factors for carotid atherosclerotic plaque formation,while female gender was an independent protective factor.After adjusting the risk factors such as age,FBG,and Hcy,etc,the risk of plaque formation of the high-normal blood pressure group was significantly higher than that of the ideal blood pressure group (odds ratio 1.354,95％ confidence interval 1.028-1.783; P =0.031),while there was no significant difference between the normotensive group and the ideal blood pressure group.Conclusions High-normal blood pressure was significantly associated with the increased risk of carotid plaque formation,which was an independent risk factor for carotid plaque formation.
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Objective To study the default mode network (DMN) of mild cognitive impairment (MCI) related to leukoaraiosis (LA) with resting-state functional magnetic resonance imaging (rs-fMRI). Methods 31 LA patients (Clinical Dementia Rating of 0.5) and 27 nor-mal controls (Clinical Dementia Rating of 0, and matched in age, gender and lever of education) were scanned with the rs-fMRI. The data was analyzed with SPM5 software, using independent component analysis. The differences between the both groups were compared with two-sample t-test. Results The DMN during resting-state of normal controls was posterior cingulate cortex/precuneus, bilateral medial fron-tal cortex, bilateral middle temporal gyrus, bilateral inferior parietal gyrus, angular gyrus, bilateral hippocampus. The DMN of MCI group was consistent with the normal controls, but the activation decreased in anterior cingulate cortex/left medial frontal lobe, right parahippcam-pus/uncus, right inferior temporal gyrus, left deep frontal white matter/head of caudate nucleus;and increased in the left caudate nucleus/an-terior cingulate cortex, left frontal lobe, and left superior temporal gyrus/inferior parietal gyrus. Conclusion Activation of resting-state func-tional network is disorder in LA, which may relate to cognitive impairment.
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Objective To evaluate the clinical efficacy of oral taking traditional Chinese medicine with functions of tonifying kidney, nourishing blood and soothing liver and external application treatment of premature ovarian failure(POF). Methods 40 patients of deficiency of liver-yin and kidney-yin type POF in Gynecology Department of Xiyuan Hospital CACMS from July 2009 to July 2013 were collected and administrated with traditional Chinese medicine with functions of tonifying kidney, nourishing blood and soothing liver and external treatment for 3 months. The changes of menstruation situation, symptoms and serum sex hormone were compared before and after the treatment. Results ① Menstruation integral were reduced after the treatment, showing a statistical significance compared with those before the treatment(t=5.694,P<0.01). ② Symptoms integral were reduced after the treatment, showing a statistical significance compared with those before the treatment(t=21.828,P<0.01). ③ Serum FSH, LH were decreased and Serum E2 were increased after the treatment,showing a statistical significance compared with those before the treatment(P<0.05). ④ The total effective rate was 92.5%(37/40). Conclusion Traditional Chinese medicine with functions of tonifying kidney, nourishing blood and soothing liver are effective for treating POF. These methods had proven to improve ovarian function by decreasing high level of FSH and LH, whereas enhancing the estrogen level, and therefore promote menstruation cycle.
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ObjectiveTo analyze the changes of imaging and the efficacy of sympathetic cervical spondylosis before and after treatment and discuss the correlation of them.Methods Seventy-one sympathetic cervical spondylosis inpatients who examined by X-ray,CT,transcranial Doppler (TCD) or color Doppler flow imaging(CDFI) were collected.After comprehensive treatment,the efficacy was evaluated according to the recovery of patients' symptoms,and the cases with imaging abnormalities were examined again.Then the correlation between the changes of imaging and the efficacy was analyzed.ResultsAfter treatment,all 71 cases,including 45 cases with excellent efficacy,18 cases with good effect and 8 cases turned effective,showed a fine rate 88.7％ (63/71) and an effective rate 100.0％ (71/71).The rechecked imaging results showed:in 36 lantoaxial subluxation cases by CT scanning,26 cases turned to be normal,6 cases were improved and 4 cases had finally no change; in 68 cases with abnormal X-ray imaging,67 cases were improved and 1 case had finally no change; in 38 cases with abnormal TCD results,24 cases turned to be normal,2 cases were improved,10 cases showed changes and 2 cases had finally no change;in 36 cases with abnormal cervical CDFI results,9 cases turned to be normal,10 cases were improved,15 cases showed changes and 2 cases had finally no change.The analysis of correlation between the changes of imaging and the efficacy showed:changes count by the value 0,r =0.388,t =3.500,P＜ 0.01 ; changes count by the value 0.5,t =0.361,t =3.211,P ＜0.01.ConclusionsThe efficacy of sympathetic cervicalspondylosis has positive correlation with the changes of imaging and the causes of this disease are complex.So complete and well inspection can help the syndrome differentiation treatment and confirm the efficacy.
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Objective: To investigate the possible mechanisms in acupuncture analgesia by interaction of &opioid receptor with neurotransmitter transport proteins or the Na+-K+pump. Methods: Microinjection of respective heterologous cRNA into the Xenopus oocytes as a model system, and measurement of steady-state currents under two-electrode voltage clamp. Results: The co-expression of the δ-opioid receptor with GAT1, EAAC1 or the sodium pump resulted in reducing activity of the respective transporter. Opioid receptor activation affected transporter activity in different ways: 1) GAT1 was further inhibited; 2) EAAC1 was stimulated; 3) Na+-K+ pump activity interfered with agonist sensitivity of DOR. Pump inhibition led to higher sensitivity for DPDPE. Conclusion: GABA transporter inhibition and glutamate transporter stimulation may counteract pain sensation by affecting the neurotransmitter concentration in the synaptic cleft and, therefore, may contribute synergistically to pain suppression by acupuncture. Sodium pump inhibition by endogenous ouabain may amplify these effects. These synergistic effects may be the molecular mechanism of inhibiting pain sense and/or acupuncture analgesia.
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Objective To investigate whether the μ- and δ-opioid receptors were involved in mediating the a ntinociceptive effect of opioid injection into the nucleus submedius (Sm). Methods Nociceptive behavior produced by subcutaneous injection of formalin (65 mmol/L, 50 μL) into the hind paw of the rat was assessed quantitatively using an automated movement detection system. The effects of morphine and selectiveμ- and δ-opioid receptor antagonists microinjected unilaterally into the Sm were determined in the awake rats. Results Morphine (31 mmol/L, 0. 5 μL) depressed the nociceptive behavior elicited by formalin, and this effect was antagonized completely by the selective μ-receptor antagonist β-funaltrexamine (β-FNA, 0. 4 mmol/L, 0. 5 μL) and naloxonazine (0.8 mmol/L, 0.5 μL), and partly by the δ-receptor antagonist naltrindole (0.4 mmol/L, 0.5μL).Administration of morphine into thalamic regions more than 0. 5 mm dorsal to the Sm had no effect on the nociceptive behavior. Conclusion Antinociceptive effects produced by opioid acting on Sm neurons are mediated mainly by μ-opioid receptors, and partly by δ-receptors.
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OBJECTIVE: To establish the quality standard of Jieyin effervescence tablet. METHODS: Dictamnus dasycarpus, Sophora flavescens, Phellodendron chinense,Cnidium monnieri, Zanthoxylum bungeanum were identified by TLC. The content of berberine was determined by HPLC. RESULTS: The TLC was specific for the identification of D. dasycarpus, S. flavescens, P. chinense,C. monnieri, Z. bungeanum. The linear range of berberine was 0.208～1.04 ?g(r=0.997 8)with an average recovery of 101.38% (RSD=1.39%,n=6). CONCLUSION: Established quality standard is applicable for the quality control of Jieyin effervescence tablet.
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Objective To study the relationship between PDD and the polymorphism of apolipoprotein E(apoE) gene,to inquire the etiological basis of PDD.Methods 11 Patients with PDD 40 patients with PD without dementtia and 52 unrelated controls were collected to detect the genotype of apoE gene by PCR－ RFLP. Results There was no difference in the apoE allele frequencies and genotype distribution in PDD group,PD without dementia group and control group(P >0.05). Conclusion There is no relationship between the polymorphism of apoEgene and the onset of PDD.The pathogenesis of PDD differs from that of AD.