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Background@#Data on the efficacy and incidence of adverse effects associated with dexmedetomidine (DEX) as a local anesthetic adjuvant for patient-controlled epidural analgesia (PCEA) are inconclusive. This meta-analysis assessed the efficacy and risks of DEX for PCEA using opioids as a reference. @*Methods@#Two researchers independently searched PubMed, Embase, Cochrane Library, and China Biology Medicine for randomized controlled trials comparing DEX and opioids as local anesthetic adjuvants in PCEA. @*Results@#In total, 636 patients from seven studies were included in this meta-analysis. Postoperative patients who received DEX had lower visual analog scale (VAS) scores than those who received opioids at 4–8 h (mean difference [MD]: 0.61, 95% CI [0.45, 0.76], P < 0.001, I2 = 0%), 12 h (MD: 0.85, 95% CI [0.61, 1.09], P < 0.001, I2 = 0%), 24 h (MD: 0.59, 95% CI [0.06, 1.12], P = 0.030, I2 = 82%), and 48 h (MD: 0.54, 95% CI [0.05, 1.02], P = 0.030, I2 = 91%). Additionally, patients who received DEX had a lower incidence of itching (odds ratio [OR]: 2.86, 95% CI [1.18, 6.95], P = 0.020, I2 = 0%) and nausea and vomiting (OR: 6.83, 95% CI [3.63, 12.84], P < 0.001, I2 = 24%). In labor analgesia, no significant differences in neonatal (pH and PaO2 of cord blood, fetal heart rate) or maternal outcomes (duration of labor stage, mode of delivery) were found between the DEX and opioid groups. @*Conclusions@#Compared with opioids, using DEX as a local anesthetic adjuvant in PCEA improved postoperative analgesia and reduced the incidence of itching and nausea and vomiting without increasing the incidence of adverse events.
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Objective@#To analyze the correlation between plasma trough level of generic imatinib and its metabolism and clinical outcomes in Chinese patients with chronic myeloid leukemia in chronic phase (CML-CP) .@*Methods@#The 21 patients with CML-CP who enrolled in a clinical trial YMTN 1.0 from Oct 11th, 2012 to May 8th, 2013 and received generic imatinib were as study subjects. The correlation between steady plasma trough levels of imatinib and its metabolism with clinical response, age, weight and body surface area (BSA) were evaluated.@*Results@#①The mean steady plasma trough level of generic imatinib and its metabolism was (1 185.07±417.91) μg/L and (251.53±76.50) μg/L, respectively. ②Age, weight and BSA has no significant effects on plasma trough level of generic imatinib and its metabolism (P>0.05) . ③Patients with steady plasma trough level of generic imatinib more than 1 000 μg/L are possible to have higher major molecular response (MMR) /complete molecular response (CMR) rate than those below 1 000 μg/L (42% vs 0, P<0.05) .@*Conclusion@#Plasma trough levels of generic imatinib varied in CML patients. The steady plasma trough levels of generic imatinib is maybe related to molecular response in CML patients.
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Objective To determine the effectiveness of an oral care protocol on prevention and treatment of chemotherapy-induced oral mucositis in patients with hematological neoplasms. Methods Totally 106 patients with hematological neoplasms undergoing therapies from March to October 2017 were enrolled. Patients who were included from March to June 2017 constituted the control group, others from July to October constituted the intervention group. Patients in control group received the regular care, while patients in intervention group received a 3-week period oral care protocol. The oral health status of the patients was recorded and compared between the two groups. Results On the 7th,14th, 21th day after chemotherapy, the oral mucositis level of I degree,Ⅱdegree,Ⅲdegree andⅣdegree of the intervention group were 11, 13, 17, 1 cases, 28, 16, 0, 0 cases, 9, 3, 0, 0 cases, which were lower than the control group whose degrees were 24, 18, 10, 2 cases, 21, 13, 12, 0 cases, 13, 9, 8, 0 cases, respectively. The difference between the two groups was statistically significant (Z=-2.177,-2.504,-2.113, P<0.05). On the 3th, 7th, 14th and 21th day after chemotherapy, the oral pain scores reported by patients in the intervention group were 2.00(2.50), 3.00(2.75), 2.50(2.00), 0.00 (1.00), which were lower than the control group whose scores, in contrast, were 3.00(4.00), 5.00(3.25), 5.50 (4.00), 2.00(3.25). The difference between the two groups was statistically significant (Z=-2.587,-3.326,-4.925,-3.217, P <0.05). The positive rate of microbial examination in the intervention group was 14.6%(7/48), which was lower than 36.2%(21/58) in the control group. The difference between the two groups was statistically significant(χ2=6.318, P<0.05). Conclusions The oral care protocol established and implemented based on evidence could effectively decrease the incidence of chemotherapy-induced oral mucositis, ease oral pain and reduce inflammation for patients with hematological neoplasms.
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Objective In pressure controlled ventilation(PCV),a self-control method was used to ob-serve the change of respiration mechanics indexes under Trendelenburg position and pneumoperitoneum versus su-pine position and non-pneumoperitoneum with preset airway pressure.Methods Thirty patients scheduled for lapa-roscopic radical resection of rectal carcinoma were enrolled in this study.ECG,MAP,SpO2,BIS and body temper-ature were routinely detected. After induction of anesthesia,volume controlled ventilation(VCV)was used as ba-sic ventilation,and then switched to PCV after 5 minutes. The airway pressure was the preset airway pressure be-fore pneumoperitoneum,then was lowered 1 cmH2O in proper order,and then restored preset airway pressure and increased 1 cmH2O. 15 minutes after pneumoperitoneum,the airway pressure of PCV was used as preset airway pressure after pneumoperitoneum,and then the above procedure was repeated.The time interval was at least 5 min-utes.The values of MAP,HR,SpO2,VT and Cdyn were recorded at each time;VT,and Cdyn were continuously recorded five times to take the average value. The postoperative recovery in patients was observed. Results After pneumoperitoneum,the values of Cdyn and VT were significantly reduced(P < 0.01),MAP was increased(P <0.05). When the preset airway pressure changed 1 cmH2O,ΔVT was decreased(P < 0.05),and the change of Cdyn was not statistically significant. Conclusions As altering a unit of the preset airway pressure in PCV,the change in VT is significantly reduced but Cdyn does not change markedly in Trendelenburg posture and artificial pneumoperitoneum,as compared with supine position and non-pneumoperitoneum.
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Objective To compare the effects of methylprednisolone and dexamethasone individually combined with tropisetron on the prevention of postoperative nausea and vomiting (PONV) of high risk in patients with thyroid surgery.Methods One hundred and sixty patients of high risk of postoperative nausea and vomiting scheduled for radical operation of thyroid with general anesthesia were randomly divided into four groups with 40 cases each.Four groups of the patients were intravenously injected methylprednisolone 40 mg plus tropisetron 5 mg at the end of the operations (group MT),dexamethasone 7.5 mg before anesthesia induction,and tropisetron 5 mg at the end of the operations (group DT),tropisetron 5 mg at the end of the operations (group T),and normal saline (group C).Incidence and severity of nausea,vomiting and adverse reactions were recorded during 24 hours after end of the operations.Results Compared to group DT,the incidences of PONV during the 0 ~ 2 h and 2 ~ 6 h,and the visual analogue scale (VAS) of PONV at 2 h after the operations in group MT were significantly lower (P < 0.05).Compared to group C,the incidences of PONV and VAS score during the 0 ~ 24 h after the operations in group MT and group DT were significantly lower (P <0.05),the incidences of PONV during the 2 ~6 h and 6 ~ 12 h after the operations,and VAS score of PONV at 6 h and 12 h after the operations in group T were significantly lower (P <0.05).Compared to group C,incidences of headache in group MT and group DT were significantly lower (P < 0.05),and incidence of swim in group T was also significantly lower (P < 0.05).Incidence of adverse reactions in group MT and group DT were no significant difference.Conclusions Preventive effect of methylprednisolone combined with tropisetron for PONV in high-risk patients within 6 hours after thyroid surgery was significantly better than that of dexamethasone combined with tropisetron.
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The present study aimed to research pathogenesis and therapeutics of hepatocellular carcinoma (HCC) with the method of tissue metabolomics.A combined gas chromatography-mass spectrometry (GC-MS) method was developed suitable for analyzing the endogenous small molecule of liver cancer tissues and adjacent tissues.The unidimensional and multidimensional statistics were used to look for differential metabolites.And then,the KEGG and HMDB database were utilized to find related differential pathways and pathogenesis of HCC.The PCA and PLS-DA showed that there were significant differences on the endogenous small molecule of liver cancer tissues and adjacent tissues.Through the OPLS-Loading plot analysis,there were 25 differential metabolites and 36 relevant pathways.The differential pathways belong to carbohydrate metabolism,amino acid metabolism and mitochondrial transfer.There were 16 metabolites' area under the ROC curve which was bigger than 0.8,which were related with ATP-binding cassette (ABC) transporters,galactose metabolism,amino sugar and nucleotide sugar metabolism.It was concluded that the Warburg effect exists in HCC cells.The energy of HCC cell was from glycolytic function,because the glycolysis was enhanced and the citric acid cycle decreased.Mitochondrial dysfunction and the increased cobalt content may correlate with the Warburg effect,which may be one of the pathogenesis of liver cancer,and expected to become the breakthrough point of a new targeting therapeutic approach.
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As the most downstream of biology information current,metabolism has the special function of information delivery.Work principle and disease mechanism of brain can be better reflected based on the combination of metabolism and gene,transcription,protein and nervous system.At present,there are many reports regarding metabolomics research in the brain to explore the diseases' effect on brain metabolism.Combined with precision medicine,precision application of metabolomics technology in brain diseases was reviewed in this paper.
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The essence of precision medicine (PM) is to find the disease pathogenesis,mechanism and treatment targets through large sample population and specific disease type of biomarker exploring,quantitative analysis,verifying and application.Metabolomics,as one of the technologies testing the metabolites in vivo,can be used to predict the level of metabolites in vivo and to diagnose the physiological state of the body in time for guiding the corresponding intervention.This article summarized the application of metabonomics in the precise diagnosis,pathogenesis and treatment of cardiovascular disease.
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OBJECTIVES: We sought to identify the expression of CD68-tumor-associated macrophages (TAMs) and CD34-microvascular density (MVD) in laryngeal squamous cell carcinoma (LSCC), to study the relationship with clinical pathological parameters and to determine whether their expression is predictive of disease. METHODS: Pathologically confirmed 45 LSCC tissue and 20 peritumoral non-tumor tissue were examined. Immunohistochemical studies were used to detect the expression of CD68-TAMs and CD34-MVD. RESULTS: The positive expression rate of CD68 in LSCC tissue was 82% (37/45), which was higher than the 10% (2/20) expression rate of the peritumoral tissue (P<0.05). The CD34-MVD positive expression rate in the LSCC tissue was 26.5±6.4, which obviously higher than 12.2±4.0 expression rate of the peritumoral tissue (P<0.05). The positive expression rates of both CD68 and CD34-MVD were higher in the lymph node metastasis (LNM) positive group than in the LNM negative group. The expression of CD68 had positive correlation with CD34-MVD. The 5-year disease-free survival rate in the group with the low CD68 expression was significantly higher than that in the group with high CD68 expression (76% vs. 42%, respectively). CONCLUSION: The high expression of CD68-TAMs in LSCC and its positive correlation with CD34-MVD illustrates that both play an important role in promoting the metastasis and angiogenesis of this cancer. Their expression was also positively correlated with the prognoses of these patients, suggesting that they could be used as important prognostic markers for LSCC.
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Humains , Carcinome épidermoïde , Survie sans rechute , Cellules épithéliales , Tumeurs du larynx , Noeuds lymphatiques , Macrophages , Métastase tumorale , PronosticRésumé
Objective To explore the effect of apolipoprotein E deficiency on astrocyte destruction in the ex vivo spinal cord slice model. Methods Vibratome-cut transverse spinal cord slices from C57BL/6 postnatal day 7 ApoE -/-mice and wild-type mice were cultured on transwell porous supports. After 7 days in the culture , spinal cord slices were exposed to LPS for 5 days. The expression of AQP4, GFAP and Iba1 was detected by immunofluorescence. The concentration of TNF-α and NO were detected by ELISA and method of nitrate reductase, respectively. Results Marked loss of AQP4 and GFAP staining were shown in LPS-affected groups, not in the control group, and the lesion score was higher in ApoE-/-group than WT-group (P<0.05). In addition, the expression of Iba1 and concentration of TNF-α, NO in the LPS-affected groups were more than that of the control group (P < 0.05), and they were higher in the ApoE-/-LPS group than the WT-LPS group (P < 0.05). Conclusions ApoE deficiency exacerbates astrocyte injury, likely through promoting the release of pro-inflammatory mediators from microglia.
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Metal or semi-metal elements have numerous physiological and biochemical properties and have correlations with the process of occurrence and development of Zheng and Chinese herbal medicine pharmacodynamics mechanism. This article will expound the current situation of traditional Chinese medicine (TCM) research based on metal elements from the researches of Zheng, medicine theory, pharmacodynamic mechanism, prescription principles, medicine concocted theory and medicine quality control in TCM. In addition to putting forward the shortages of current researches, we also introduce metallomics, the member of Omics in systems biology to offer a new idea for modernization of TCM based on metal elements.
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OBJECTIVE@#To study the expression of CD68 antibody marked tumor associated macrophage TAMs and matrix solution element MMP-7 in laryngeal squamous carcinoma tissue and the relationship with clinicopathological parameters, so that to explore the relationship between the expression of the two molecular markers and laryngeal cancer tissue microvascular density (MVD).@*METHOD@#Immunohistochemical method was employed to detect the expression of CD68 and MMP-7 in 65 cases (laryngeal squamous carcinoma tissue in 45 cases; peritumoral nontumor tissue in 20 cases) and CD 34 antibody marked MVD expression.@*RESULT@#CD68 positive rate in squamous carcinoma tissue (82.2%, 37/45) is obviously higher than that in the peritumoral tissue (15%, 3/20) (P < 0.05), and MMP-7 positive rate in squamous carcinoma tissue is significantly different from that in peritumoral tissue (71.1%; 25%) (P < 0.05). The expression rate of CD34-MVD in laryngeal squamous carcinoma tissue( 26.52 +/- 6.36 )is higher than that in peritumoral tissue (12.23 +/- 4.01) (P < 0.05). In lymph node metastasis group, the positive expression rates of CD68 and MMP-7 are higher than those in the group without lymph node metastasis. MMP-7 showed no correlation with cancer stage, and CD68 was related with cancer stage; CD68, MMP-7 and CD34- MVD have positive correlation.@*CONCLUSION@#The high level of expression of TAMs and MMP-7 in laryngeal cancer tissue and the positive correlation with MVD illustrate that both of the markers play important roles in promoting laryngeal squamous carcinoma tissue metastasis and angiogenesis, which can be used as important markers to evaluate the invasion and metastasis of laryngeal cancer.
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Adulte , Sujet âgé , Humains , Mâle , Adulte d'âge moyen , Antigènes CD , Métabolisme , Antigènes CD34 , Métabolisme , Antigènes de différenciation des myélomonocytes , Métabolisme , Carcinome épidermoïde , Métabolisme , Anatomopathologie , Tumeurs du larynx , Métabolisme , Anatomopathologie , Métastase lymphatique , Macrophages , Biologie cellulaire , Métabolisme , Matrix metalloproteinase 7 , Métabolisme , Microvaisseaux , Stadification tumorale , Néovascularisation pathologiqueRésumé
A case of lymphoepithelial was reported and the literature were reviewed. Early surgical treatment can help to get the better prognosis. There is currently no effective treatment methods and the disease have no lethal tendency. The early surgical treatment is recommended for its possibility of canceration.
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Humains , Mâle , Adulte d'âge moyen , Maladies lymphatiques , Anatomopathologie , Glandes salivaires , AnatomopathologieRésumé
Early lymph node metastasis is a common clinical phenomenon in many human cancers, which is associated with both aggressive disease and poor prognosis. Clearly, treatments to specifically block dissemination through the lymphatic network would be desirable either as independent therapies or as adjuncts to existing chemotherapy. At the present stage the target vessels for invasion by lymph-metastasizing tumor cells include preexisting tissue lymphatics abutting the tumor mass through either coincidence or mutual chemoattraction, as well as new lymphatic vessels that proliferate either within or around the tumor as a result of lymphangiogenesis. The lymphangiogenesis is regulated primarily by the lymphangiogenic growth factors VEGF-C and VEGF-D generated by tumor cells or host cells including tissue macrophages. Nevertheless, it remains controversial as to whether this metastasis-enhancing effect simply results from an increase of the number of target vessels due to mitogenesis or from other properties of the newly dividing tumor lymphatics.
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Objective To explore the efficacy of closed reduction with cannlated compression screws for the treatment of elderly paitents with intertrochanteric fracture.Methods From April 2002 to July 2006,guided by a C-arm X-ray system,58 elderly patients with intertrochanteric fracture were treated by closed reduction with cannlated compression screws.Results The mean operation time was 55 minutes(40 to 70 minutes),and the mean blood loss was 35 ml(30 to 40).The patients were discharged from hospital in 3 to 10 days after the operation(mean,6.5 days).All of the 58 patients were cured.According to criteria for evaluating the outcomes of intertrochantenic fracture,28 cases were excellent,25 were good,3 were fair,and 2 were poor.The Rate of excellent and good outcomes was 91.4%(53/58).Conclusion Closed reduction with cannlated compression screws is effective for elderly paitents with intertrochanteric fracture.
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As a special service,blood donation has special requirements for the ethics of blood donors,which is different from the professional ethics of ordinary employees or the social ethics of the general public.The present ethical status of blood donors calls for a new way of effectively cultivating the ethics of blood donors.
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OBJECTIVE:To discuss the reasons of false drug advertisement,and to suggest the countermeasures against it.METHODS:The reasons of false drug advertisement were analyzed by using the knowledge of law,governmental admin?istration and economy.RESULTS&CONCLUSION:The countermeasures against false drug advertisement were suggested.Firstly,the regulations on defining false drug advertisement should be improved.The legal responsibilities should be specified and the punishment on the violators should be more severe.Secondly,the government should strengthen the law enforcement,and establish the credibility system and regulation for claim.Thirdly,the pharmaceutical enterprises should be self-disci?plined,and improve their professional credibility.Fourthly,the governmental departments of business administration should take a strict control on awarding advertisement license to the media.Last but not the least,the consumers should improve their common medical knowledge.
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OBJECTIVE:To probe into the economic reasons accountable for government's failure in compulsive drug pricing and put forward the countermeasure on how to strengthen the effect of compulsive pricing of the government.METHODS:Economic model was applied in the deduction and demonstration.RESULTS & CONCLUSIONS:Government's failure in setting compulsive drug prices is rooted from the imperfect pricing system.To strengthen the effect of governmental drug pricing,it is necessary to establish some supporting measures such as to tighten control on drug recommenders,shift from governmental compulsive pricing to governmental authorization to avoid excessive competition,and give reasonable compensations for special drug manufacturers etc.