A retrospective analysis to estimate trough concentrations of teicoplanin in patients with suspected or documented Gram-positive infections

Abstract Teicoplanin is a glycopeptide antibiotic commonly used to treat Gram-positive bacterial infections in the clinic. The aim of this study was to provide a therapeutic reference for the clinical application and dosage regimen adjustment of teicoplanin by identifying factors associated with its plasma trough concentration (Ctrough). A retrospective study was performed on patients with suspected or documented Gram-positive infections who were hospitalized from November 2017 to January 2020 and treated with teicoplanin while undergoing routine therapeutic drug monitoring (TDM). A total of 112 Ctrough trough measurements were obtained from 72 patients were included in this study. SPSS software was used for correlation analysis and receiver operator characteristic curve (ROC) analysis. The Ctrough for teicoplanin showed statistically significant relationships (P<0.05) with PLT, Scr, CLcr, eGFR, BUN and Cys-C. ROC curve analysis revealed that CLcr and eGFR were more sensitive and specific for Ctrough compared to the other factors. These findings should be considered in the clinical application of teicoplanin and for its dosage adjustment.

Application of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy / 中国医师杂志

Objective:To investigate the effect of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy.Methods:90 elderly patients undergoing pancreaticoduodenectomy were randomly divided into methoxyamine group and control group, with 45 cases in each group. The patients in both groups were treated with intravenous inhalation combined anesthesia. The stroke volume variation (SVV) was maintained at 7%-10% and the central venous pressure (CVP) was 4-8 cmH 2O. In methoxyamine group, 3 μg/(kg·min) methoxyamine was continuously pumped, while the control group was pumped with the same amount of normal saline at the same speed. The intraoperative infusion volume, urine volume, bleeding volume, blood transfusion cases, intraoperative mean arterial pressure, heart rate, blood gas analysis results, B-type natriuretic peptide (BNP), creatinine, urea nitrogen level and postoperative exhaust time were compared between the two groups. Results:Compared with the control group, the patients in methoxyamine group had less infusion volume, urine volume, lower postoperative BNP level and heart rate, shorter postoperative exhaust time (all P<0.05), and higher mean arterial pressure ( P<0.05). There was no significant difference in blood loss, blood transfusion cases, PaO 2, PaCO 2, pH, creatinine and urea nitrogen between the two groups (all P>0.05). In addition, the number of patients in the methoxyamine group who used pressor drugs was less than that in the control group ( P<0.05), and the frequency of bradycardia was more than that in the control group ( P<0.05). The proportion of tachycardia and urapidil was similar in the two groups (all P>0.05). Conclusions:Methoxyamine combined with target guided fluid therapy can reduce the intraoperative infusion volume of pancreaticoduodenectomy in elderly patients, stabilize circulation, shorten postoperative exhaust time, and contribute to the recovery of gastrointestinal function.

Genome-wide identification and transcriptional profiling analysis of PIN/PILS auxin transporter gene families in Panax ginseng / 中草药·英文版

Objective: Plant hormones act as chemical messengers in the regulation of plant development and metabolism. The production of ginsenosides in Panax hybrid is promoted by auxins that are transported and accumulated by PIN-FORMED (PIN) and PIN-LIKES (PILS) auxin transporters. However, genome-wide studies of PIN/PILS of ginseng are still scarce. In current study, identification and transcriptional profiling of PIN/PILS gene families, as well as their potential relationship with ginsenoside biosynthesis in Panax ginseng were investigated. Methods: PIN/PILS genes in P. ginseng was identified via in silico genome-wide analysis, followed by phylogenetic relationships, gene structure, and protein profiles investigation. Moreover, previously reported RNA-sequence data from various tissues and roots after infection were utilized for PIN/PILS genes expression pattern analysis. The Pearson's correlation analysis of specific PIN/PILS genes expression level and main ginsenoside contents were taken to reveal the potential relationship between auxin transports and ginsenoside biosynthesis in P. ginseng. Results: A genome-wide search of P. ginseng genome for homologous auxin transporter genes identified a total of 17 PIN and 11 PILS genes. Sequence alignment, putative motif organization, and sub-cellular localization indicated redundant and complementary biological functions of these PIN/PILS genes. Most PIN/PILS genes were differentially expressed in a tissue-specific manner, and showed significant correlations with ginsenoside content correspondingly. Eight auxin transporter genes, including both PIN and PILS subfamily members, were positively correlated with ginsenoside content (cor > 0.60; P-value <0.05). The expression levels of eleven auxin transporter genes were increased dramatically in the early stage (0–0.5 DPI) after Cylindrocarpon destructans infection, accompanied with various overall expression patterns, implying the dynamic auxin transport in response to biotic stress. Conclusion: Based on the results, we speculate that the accumulation or depletion in temporal or spatial manner of auxin by PIN/PILS transporters involved in the regulation of HMGR activity and subsequent ginsenoside biosynthesis.

Progress in Application of Population Pharmacokinetic and Pharmacodynamic Models in Research on Traditional Chinese Medicine / 中国实验方剂学杂志

In recent years， the role of quantitative pharmacological models in applicable population of drugs and dose optimization has been widely recognized. In order to improve the efficiency of clinical development and optimize clinical rational drug use， quantitative pharmacological models are being gradually introduced into the research of traditional Chinese medicine （TCM）. There are various types of quantitative pharmacological models， among which the following three models are commonly used：①Population pharmacokinetic （PPK） model， which is mainly used to explore the pharmacokinetic characteristics in different populations.②Pharmacokinetic-pharmacodynamic （PK-PD） model， which is used to reveal the internal relationship among dose， time and efficacy. ③PPK-PD model， which integrates both the characteristics of PPK model and PK-PD model. The paper summarizes the application of the above three models in TCM， and extracts the main ideas and methods of TCM model research， in order to provide reference for clinical research and rational use of TCM.

Value of intraoperative Surgical Apgar Score in predicting postoperative delirium in patients undergoing pancreaticoduodenectomy / 中华麻醉学杂志

Clinical data of patients underwent pancreaticoduodenectomy due to malignant ampullary tumors from January 2013 and December 2016 in our hospital with full access to medical records were collected,and 144 patients were enrolled in total.Surgical Apgar Score (SAS) was calculated based on the intraoperative lowest mean arterial pressure,lowest heart rate and blood loss.The patients were divided into 2 groups depending on whether postoperative delirium developed or not within 7 days after surgery.The receiver operating characteristic curve of SAS in predicting postoperative delirium was drawn.The area under the curve,optimal cut-off value and sensitivity and specificity were calculated.Thirty-six patients developed postoperative delirium,and the incidence was 25.0％.The area under the curve of SAS in predicting postoperative delirium was 0.86 (95％ confidence interval 0.79-0.91).The optimal cut-off value was 6 with a sensitivity of 86％ and a specificity of 83％.In conclusion,intraoperative SAS can predict the development of postoperative delirium in patients undergoing pancreaticoduodenectomy.

Genome-wide characterization and analysis of bHLH transcription factors in

Ginseng ( C.A. Meyer) is one of the best-selling herbal medicines, with ginsenosides as its main pharmacologically active constituents. Although extensive chemical and pharmaceutical studies of these compounds have been performed, genome-wide studies of the basic helix-loop-helix (bHLH) transcription factors of ginseng are still limited. The bHLH transcription factor family is one of the largest transcription factor families found in eukaryotic organisms, and these proteins are involved in a myriad of regulatory processes. In our study, 169 bHLH transcription factor genes were identified in the genome of , and phylogenetic analysis indicated that these PGbHLHs could be classified into 24 subfamilies. A total of 21 RNA-seq data sets, including two sequencing libraries for jasmonate (JA)-responsive and 19 reported libraries for organ-specific expression analyses were constructed. Through a combination of gene-specific expression patterns and chemical contents, 6 PGbHLH genes from 4 subfamilies were revealed to be potentially involved in the regulation of ginsenoside biosynthesis. These 6 PGbHLHs, which had distinct target genes, were further divided into two groups depending on the absence of MYC-N structure. Our results would provide a foundation for understanding the molecular basis and regulatory mechanisms of bHLH transcription factor action in .

The Role of CBS in Injury Time Estimation after Brain Contusion / 法医学杂志

OBJECTIVES@#To observe the changes of cystathionine β-synthase （CBS） expression in the cerebral cortex after brain contusion at different times.@*METHODS@#An experimental model of traumatic brain injury （TBI） in mice was established by an improved weight-drop device. Then Western blotting and immunohistochemical examination were used to detect the CBS expression in cerebral cortex around injury at different time points （1 h, 6 h, 12 h, 1 d, 2 d, 3 d, 7 d）.@*RESULTS@#The results of Western blotting revealed that the expression level of CBS was down-regulated and reached its lowest level at the 3rd days after injury, and then restored to normal level after 7 days. The results of immunohistochemistry showed that CBS was present in the normal brain cortex. CBS expression gradually decreased at the 3rd days after injury, and then restored to normal level after 7 days.@*CONCLUSIONS@#CBS has the potential to be a reference index for time estimation after brain contusion in forensic practice.

The Role of CBS in Injury Time Estimation after Brain Contusion / 法医学杂志

Objective T o observe the changes of cystathionine β-synthase (C B S ) expression in the cere-bral cortex after brain contusion at different tim es. Methods A n experim ental m odel of traum atic brain injury (T B I) in m ice w as established by an im proved w eight-drop device. T hen W estern blotting and im m unohistochem ical exam ination w ere used to detect the C B S expression in cerebral cortex around in-jury at different tim e points (1 h, 6 h, 12 h, 1 d, 2 d, 3 d, 7 d). Results T he results of W estern blotting revealed that the expression level of C B S w as dow n-regulated and reached its low est level at the 3rd days after injury, and then restored to norm al level after 7 days. T he results of im m unohistochem istry show ed that C B S w as present in the norm al brain cortex. C B S expression gradually decreased at the 3rd days after injury, and then restored to norm al level after 7 days. Conclusion C B S has the potential to be a reference index for tim e estim ation after brain contusion in forensic practice.

Effects of Different Doses of Nalbuphine Combined with Propofol on Anesthesia and Analgesic Effect of Pa-tients Underwent Hysteroscopic Surgery / 中国药房

OBJECTIVE:To investigate effects of different doses of nalbuphine combined with propofol on anesthesia and anal-gesic effect of patients underwent hysteroscopic surgery. METHODS:A total of 120 inpatients undergoing painless hysteroscopic surgery were selected as research objects during Feb.-Nov. 2016. They were divided into group P,N1,N2,N3 according to ran-dom number table,with 30 cases in each group. Routine preoperative preparation was conducted in 4 groups. Group N1,N2,N3 were given Nalbuphine hydrochloride injection 0.05,0.10,0.15 mg/kg slowly,iv,within 1-2 min. After 3 min of injection,4 groups were given 2％ Lidocaine hydrochloride injection 2 mL,iv+ Propofol injection 1 mg/kg,iv(40 mg/10 s),and then injected with Propofol injection(10 mg/10 s)slowly until the patient's eyelash reflex disappeared and no response was aroused. During sur-gery,Propofol injection was infused with micro pump at 6 mg/(kg·h)to maintain anesthesia until the end of operation. The levels of hemodynamic parameters (SBP,DBP,HR) and SpO2 of 4 groups were observed after admission to operating room (T0),be-fore propofol infusion(T1),immediately after propofol infusion(T2),during uterine cervical distension(T3),at the end of surgery (T4) and during anesthesia recovery (T5),respectively. The induction dose,maintenance dose,total dose,total dosing time and unit time dose of propofol,anesthesia recovery time and NRS scores after anesthesia recovery of patients were also observed in 4 groups. The occurrence of ADR was recorded during operation and anesthesia recovery. RESULTS:There was no statistical signifi-cance in maintenance dose and total dosing time of propofol,the incidence of body motion reaction,hypotension,sinus bradycar-dia,nausea and vomiting among 4 groups (P>0.05). At T0,there was no statistical significance in hemodynamic parameters or SpO2 among 4 groups(P>0.05). Compared to T0,SBP of 4 groups were decreased significantly at T2,that of group N1 was de-creased significantly at T3-T4,and that of group N2 was decreased significantly at T3,with statistical significance(P<0.05). DBP of 4 groups were decreased significantly at T2,that of group N1 was decreased significantly at T3-T5,and that of group N2 was de-creased significantly at T3,with statistical significance (P<0.05). HR of group P was decreased significantly at T3,and that of group N3 was decreased significantly at T5,with statistical significance (P<0.05). SpO2 of 4 groups were decreased significantly at T2,and that of group N3 was decreased significantly at T3,with statistical significance(P<0.05). SpO2 of group N3 at T1 was significantly lower than that of group P;at T2,it was significantly lower than other groups;at T3,it was significantly lower than group P and N1,with statistical significance (P<0.05). Compared to group P,induction dose,total dose and unit time dose of propofol,NRS scores of patients were significantly decreased in group N2 and N3;the anesthesia recovery time of group N1,N2, N3 were shortened significantly,with statistical significance(P<0.05). Compared with group N1,induction dose,total dose and unit time dose of propofol,NRS scores were significantly decreased in group N2 and N3,and anesthesia recovery time of them were shortened significantly,with statistical significance(P<0.05). Compared to group N2,induction dose and total dose of pro-pofol were decreased signigficantly in group N3,with statistical significance(P<0.05). Compared with group P,the incidence of dizziness was increased significantly in group N3;compared with group P,N1,N2,the incidence of hypoxemia was increased sig-nificantly in group N3,with statistical significance (P<0.05). CONCLUSIONS:Nalbuphine 0.10 mg/kg combined with propofol for hysteroscopic surgery can achieve good anesthesia and analgesic effect with high safety.

Quality Standard Improvement for Compound Huanghuai Tablets / 中国药师

Objective:To improve the quality standard for compound Huanghuai tablets. Methods: The main components of the preparation including Flos Sophorae Immaturus, Radix Scutellariae Baicalensis, Radix Paeoniae Rubra, Radix et Rhizoma Rhei Palma-ti, Rhizoma Imperatae, Caulis Spatholobi, Semen Coicis and Spica Prunellae Vulgaris were identified by TLC qualitatively. The content of rutin in Flos Sophorae Immaturus was determined by HPLC. A DIKMA? Spursil C18 (250 mm × 4. 6 mm, 5 μm) column was used with methanol-0. 2% phosphoric acid solution (45:55) as the mobile phase. The flow rate was 1. 0 ml·min-1 , the detection wave-length was set at 350 nm, the column temperature was maintained at 25℃, and the injection volume was 20μl. Results:The spots in TLC were clear without any interference. The calibration curve was linear within the range of 0. 0116-0. 1859 mg · ml-1 ( r =0. 9999) for rutin. The average recovery was 98. 93% (RSD=1. 14%,n=6). Conclusion: The improved quality standard is sim-ple, specific and reproducible, which can be used for the quality control of compound Huanghuai tablets.

Quality Standard Improvement for Qingyuantiaozhi Capsules / 中国药师

Objective:To improve the quality standard for Qingyuantiaozhi capsules. Methods:The main components of the prep-aration, such as Chrysanthemum, Anthraquinones, Hawthorn and Radix Rehmanniae Preparata, were identified by TLC qualitatively. The content of chlorogenic acid in chrysanthemum was determined by HPLC. A DIKMA Spursil C18(250 ×4.6 mm,5 μm)column was used with methanol-0. 2% phosphoric acid solution(9 ∶91) as the mobile phase. The flow rate was 1. 0 ml·min-1, the detection wavelength was set at 327 mn and the sample size was 20 μl. Results:The spots in TLC were clear without any interference. The cali-bration curve was linear within the range of 4. 425 2-30. 976 4μg·ml-1(r=0. 999 9) for chlorogenic acid. The average recovery was 101. 18% (RSD=1. 88%, n=6). Conclusion:The improved quality standard is specific, accurate and reproducible, which can be used for the quality control of Qingyuantiaozhi capsules.

Comparison of Etomidate-Dexmedetomidine and Propofol-Dexmedetomidine sedation in patients with gastroesophageal relfux disease treated by endoluminal radiofrequency ablation / 中国内镜杂志

Objective To compare the efficacy and safety of Etomidate-Dexmedetomidine and Propofol-Dexmedetomidine sedation in patients undergoing endoscopic radiofrequency ablation of gastroesophageal relfux disease (GERD).Methods Sixty adult patients, scheduled for elective endoluminal radiofrequency ablation for GERD under sedation were prospectively randomized into Etomidate-Dexmedetomidine (Group-E,n = 30) or Propofol-Dexmedetomidine (Group-P,n = 30) group. A bolus of 0.2 μg/kg of intravenous Dexmedetomidine was followed by intermittent Etomidate or Propofol injection during the procedure in order to maintain a proper depth of sedation with a Ramsay sedation scores of 5~6. Heart rates, mean blood pressure, oxygen saturation, respiratory rates and Ramsay sedation scores were recorded before sedation (T0), at the beginning of the examination (T1), during radiofrequency energy delivery (T2), at the time of gastroscopy (T3) and at the end of therapy (T4). Inter-group differences in sedation proifles (duration, time to recovery, incidence of body movement, Ramsay sedation scores and satisfaction of patient and endoscopist) and cardio-respiratory responses (heart rate, mean arterial pressure, oxygen saturation) were determined during and after radiofrequency ablation.Results No difference was found for therapy duration, anesthesia time or the time to recovery between Group-P and Group-E. Patients receiving Propofol experienced more bradycardia (Ρ = 0.032) and had higher incidences of vasoactives used (Ρ = 0.002) compared with that receiving Etomidate. Oxygen saturation in T1 (Ρ = 0.023) and T2 (Ρ = 0.009) was lower in the Group-P. No significant difference was found for other indicators.Conclusion Etomidate-Dexmedetomidine sedation was superior to Propofol-Dexmedetomidine sedation for GERD radiofrequency therapy with more stable cardio-respiratory responses.

Diagnosis and multi-modality treatment of adult pulmonary plastoma: Analysis of 18 cases and review of literature

The clinical data of 18 patients with PB from April 1989 to April 2013 was analyzed retrospectively, including 11 men and 7 women, aged 45 and 76 years old (mean 53 years). There were 12 cases of PB occurring in right lung and other cases in left lung. Among them, 3 patients had no symptoms, and 15 patients displayed symptoms of cough, chest pain, asthenia or minor haemoptysis. Overall, 11 patients had a preoperative diagnosis of lung cancer, 7 patients were preoperatively diagnosed as the other diseases, which included lung benign tumor (n=5) and mediastinal mass (n=2). All patients received a radical resection. Six patients received postoperative cisplatin-based chemotherapy, and two patients received postoperative irradiation with the dose of 55 Gy. Histologically, 14 cases of 18 patients had biphasic pulmonary blastoma and four cases had well differentiated fetal adenocarcinoma. A total of 12 patients died in a period of 6-36 months after operation, and 1 case was lost after 2 years of follow up. The median survival time was 19 months. PB is a rare primary lung malignant embryonal neoplasm. Despite its assumed embyonal origin, the tumor has a predilection for adults. A preoperative correct diagnosis is very difficult in spite of modern diagnostic imaging and biopsy techniques. Surgical resection is the main method for diagnosis and treatment. Postoperative chemotherapy or irradiation can help eliminate tumor remnants. Its prognosis is very poor, especially for the biphasic type.

Association between folate intake, serum folate levels and the risk of lung cancer: a systematic review and meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Folate plays a critical role in nucleotide synthesis and DNA methylation, and was considered to be associated with anti-carcinogenesis.</p><p><b>RESULTS</b>from studies that concern the relationship between the folate intake or serum folate levels and lung cancer risk showed no consistency, which requires our further comprehensive meta-analysis.</p><p><b>METHODS</b>Systematic literature search was conducted to identify the relevant studies (published prior to February 2013) according to standard protocol. Estimated effects were calculated under both random-effects and fixed-effects models. Heterogeneity between studies and publication bias were also evaluated.</p><p><b>RESULTS</b>A total of 4390 cases and 6138 controls from 6 case-control studies revealed a significant overall inverse association between folate intake and lung cancer risk (OR = 0.74, 95%CI = 0.65 - 0.84, P < 0.001). Summary of 1438 cases and 2582 controls from 4 case-control studies and 44 cases out of a cohort of 1988 participants suggested a marginal association without significance (OR = 0.78, 95%CI = 0.60 - 1.02, P = 0.075) between high serum folate levels and less lung cancer susceptibility; however, subgroup analysis about population-based case-control studies showed that high serum folate levels significantly associated with the reduced lung cancer risk (OR = 0.76, 95%CI = 0.58 - 1.00, P = 0.048).</p><p><b>CONCLUSION</b>Higher folate intake can be a protective factor against lung cancer risk, and higher serum folate level is probably associated with reduced lung cancer risk in marginal manner, though more studies are warranted to confirm these associations.</p>

Patterns and incidence of sinonasal malignancy with orbital invasion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sinonasal malignancy with orbital invasion is rare. The objective of the current study was to evaluate the clinical and pathological features, treatment outcomes and survival rates for these malignancies.</p><p><b>METHODS</b>Ninety-three patients who were treated between 1997 and 2007 were retrospectively reviewed. Age, life style, symptoms, location of lesions, previous occurrences, histological subtypes, and treatment modalities were analyzed.</p><p><b>RESULTS</b>Ninety-three patients were evaluated, including 51 men and 42 women: the gender ratio was 1.2 men to 1.0 women. The median age was 40.5 years old. The nasal cavity (34.4%), the maxillary sinus (29.0%) and the ethmoid sinus (19.4%) were the most common primary malignant tumor sites. Almost half of the patients, 44.1% had squamous cell carcinoma, 13.9% had neuroectodermal carcinoma, 11.7% had rhabdomyosarcoma, 9% had adenocarcinoma and salivary gland-type carcinoma, and 11% had other malignancy. The majority of patients presented with T3/T4 (99%), N0 (93.1%), M0 (98%) disease. The distant metastasis rate was 20.9%. The overall survival and disease-free survival rates were 68.1% and 40.9% at three years, respectively. When the overall survival rate was computed according to the epicenter of the original malignant tumor, patients with nasal cavity malignancy and maxillary sinus had the best survival, and patients with ethmoid sinus malignancy had the worse survival (P = 0.03). According to their pathology classification, patients with rhabdomyosarcoma had worse overall survival than those with squamous cell carcinoma, or neuroendocrine carcinoma (P < 0.001). Squamous cell carcinoma and rhabdomyosarcoma invaded the orbit more often and malignancy of the nasal cavity invaded the orbit more than malignancy of the nasal sinus.</p><p><b>CONCLUSIONS</b>For nasal orbital tumors early diagnosis is crucial. Orbital exenteration and postoperative rehabilitation should be carefully considered. The current data suggest that surgical resection with postoperative radiation therapy may offer durable local control.</p>

Treatment of 336 cases of chest trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To summarize the clinical features, diagnosis and treatment of chest trauma.</p><p><b>METHODS</b>A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011.</p><p><b>RESULTS</b>Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respiratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas.</p><p><b>CONCLUSIONS</b>(1) For patients with severe chest trauma, early emergency treatment is crucial to save life. (2) Open thoracic surgery is needed for acute cardiac tamponade, intrapulmonary vascular injuries, progressive intrathoracic bleeding, lung laceration, tracheal breakage, and diaphragmatic injury. In addition, operative timing and method should be well chosen. (3) Pulmonary contusion is one of common complications in chest trauma, for which the combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.</p>

Surgical treatment and prognosis of octogenarians with non-small cell lung cancer

OBJECTIVE@#To explore the clinical characteristics, surgical treatment and prognosis of non-small cell lung cancer (NSCLC) among elderly patients over 80 years.@*METHODS@#The clinical data, surgical methods, perioperative management, postoperative complications and prognosis of 52 NSCLC patients aged over 80 years were retrospectively analyzed.@*RESULTS@#Out of 52 cases, 27 had a long-term smoking history (51.9%) and 44 were with other diseases (84.6%). Lobectomy was done in 32 cases (65.4%), sub-lobectomy in 20 cases (38.5%), including pulmonary wedge resection in 16 cases (30.8%) and lung segment resection in 4 cases (7.7%). The postoperative complication rate was 44.2% (23/52); the complication rate after lobectomy was 62.5% (20/32) and that after sub-lobectomy was 25% (5/20), with significant difference between lobectomy and sub-lobectomy (P0.05).@*CONCLUSIONS@#Octogenarians with NSCLC are often afflicted with comorbidity, so perioperative management is more complex. Strictly adhering to indications, surgery is still an important treatment of NSCLC patients over 80.

Combination of single-port thoracoscopy and laparoscopy for the treatment of esophageal carcinoma: report of 6 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the feasibility and early results of radical resection of esophageal carcinoma using single-port thoracoscopy combined with laparoscopy.</p><p><b>METHODS</b>From March 2010 to December 2010, 6 patients with esophageal carcinoma underwent radical resection by single-port thoracoscopy combined with laparoscopy in the General Hospital of People's Liberation Army. With the patients at a supine position, laparoscopy was performed to complete stomach mobilization and abdominal lymph node dissection. Thoracoscopy was then carried out with the patients lying on the left to mobilize the esophagus and dissect thoracic lymph nodes. Finally, the stomach was pulled into the thoracic cavity via the hiatus of the diaphragm to construct a tube-like stomach, which was then anastomosed to the esophagus using the OrVil system.</p><p><b>RESULTS</b>No patient was converted to open surgery during the operation. The total operative time ranged from 200 to 320 min. The mean laparoscopic time was 75(range, 45-90) min, and the mean thoracoscopic time 160(120-240) min. The mean intraoperative blood loss was 220(160-300) ml. The mean lymph node retrieval was 12(9-18). No anastomotic fistula, chylothorax, lung infection were found postoperatively.</p><p><b>CONCLUSION</b>After esophageal resection using single-port thoracoscopic and laparoscopy, reconstruction using OrVil system is safe and feasible.</p>

Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Thymectomy is considered the most effective treatment in patients with myasthenia gravis. This study aimed to explore the predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.</p><p><b>METHODS</b>Clinical records of 243 patients with myasthenia gravis who underwent thymectomy were reviewed retrospectively. The following factors were analyzed in relation to the occurrence of myasthenic crisis after thymectomy: gender, age, duration of symptoms, Osserman stage, history of myasthenic crisis, concomitant diseases, preoperative pyridostigmine dose, preoperative steroid therapy, operation approach, operation time, presence of thymoma, major postoperative complications.</p><p><b>RESULTS</b>Forty-four patients experienced postoperative myasthenic crisis during the first month after thymectomy. Univariate analysis revealed that Osserman stage (RR = 0.0976, P = 0.000), history of myasthenic crisis (RR = 0.2309, P = 0.012), preoperative pyridostigmine dose (RR = 0.4349, P = 0.016), thymoma (RR = 0.0606, P = 0.000), and major postoperative complications (RR = 0.1094, P = 0.000) were significantly related to postoperative myasthenic crisis. Multivariate Logistic regression analysis showed that Osserman stage (IIb + III + IV) (RR = 0.0953, P = 0.000), thymoma (RR = 0.0294, P = 0.000), and major postoperative complications (RR = 0.0424, P = 0.000) independently predict postoperative myasthenic crisis.</p><p><b>CONCLUSION</b>Osserman stage (IIb + IIIb + IV), thymoma and major postoperative complications are independent predictors of postoperative myasthenic crisis in patients with myasthenia gravis who underwent thymectomy.</p>

Simultaneous Determination of Silybin A and Silybin B in Rat Plasma and Pharmacokinetic Study / 中草药·英文版

Objective To investigate the bioavailability and pharmacokinetics of silybin A and silybin B in rats,respectively.Methods Following iv and ig administration of silybin to 20 Wistar rats,the plasma samples were collected at different time points up to 12 h.Sample pretreatment was involved in one-step protein precipitation with acetonitrile.Silybin A and silybin B were simultaneously determined by LC-MS/MS.Results After ig dosing silybin 28,56,and 112 mg/kg to rats,the t1/2β values were 5.48,5.08,and 5.73 h for silybin A,and 4.56,4.12,and 5.53 h for silybin B; The Cmax were 674.3,1349.4,and 2042.5 ng/mL for silybin A,and 671.0,1365.4,and 2066.2 ng/mL for silybin B; The Tmax were 0.20,0.23,and 0.20 h for silybin A,and 0.20,0.23,and 0.20 h for silybin B; The AUC were 454.4,845.9,and 1219.5 h·ng/mL for silybin A,and 432.0,817.1,and 1153.6 h·ng/mL for silybin B.The absolute bioavailabilities of silybin A and silybin B were 2.86％ and 1.93％,respectively.Conclusion Silybin A and silybin B have very low bioavailability after ig administration,and there is no significant difference in the pharmacokinetic parameters between silybin A and silybin B,which indicates that the two diastereoisomers have similar pharmacokinetic behavior in rats.