Expert consensus on late stage of critical care management / 中华内科杂志

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

Molecular epidemiological investigation on Theileria in yellow cattle from Xiangxi Autonomous Prefecture of Hunan Province / 中国血吸虫病防治杂志

Objective To investigate the prevalence and genetic variation of Theileria in yellow cattle in Xiangxi Autonomous Prefecture of Hunan Province. Methods A total of 184 blood specimens were collected from Fenghuang, Huanyuan and Baojing counties of Xiangxi Autonomous Prefecture during the period from August 2018 through August 2019, and were detect using PCR assay with the specific 18S ribosomal rRNA (18S rRNA) gene targeting Theileria. The gene sequences of positive specimens were aligned with the sequences recorded in GenBank, and a phylogenetic tree was created with Plasmodium ovale 18S rRNA as an outgroup. Results A total of 143 blood samples were positive for Theileria, with a mean detection rate of 77.7%. Theileria was prevalent in the blood samples from yellow cattle in all three counties, with detection rates of 85.0% in Fenghuang County, 88.3% in Huayuan County and 61.0% in Baojing County, respectively. There was no significant difference in the detection rate of Theileria between Xiangxi yellow cattle and normal yellow cattle (77.2% vs. 79.5%; χ2 = 0.08, P > 0.05), while the detection of Theileria was significantly lower in the housed yellow cattle than in free-range cattle (68.9% vs. 89.7%; χ2 = 22.36, P < 0.01). A total of 18 PCR positive samples were randomly selected for sequencing and analysis, and all samples showed more than 99.0% homology with T. luwenshuni isolates. Phylogenetic analysis showed that the 18 positive samples were clustered into the same branch with T. luwenshuni, but were far away from other isolates. Conclusions The prevalence of Theileria is high in yellow cattle from Xiangxi Autonomous Prefecture of Hunan Province, and T. luwenshuni may be the dominant parasite species.

Investigation and Analysis of Non-ABO Hemolytic Disease of the Newborn / 中国实验血液学杂志

OBJECTIVE@#To study the serological detection characteristics and antibody specific distribution of hemolytic disease of the newborn (HDN) caused by irregular antibodies through retrospective case analysis.@*METHODS@#A total of 3 047 suspected cases of HDN were submitted by the Neonatal Department of our hospital from January 2014 to December 2019. Non ABO-HDN cases confirmed in our laboratory were taken as the research objects, while some cases of ABO-HDN were randomly selected as control. Disease-causing antibody specificity, serological detection characteristics, total bilirubin change trend and gender ratio of non ABO-HDN patients were explored.@*RESULTS@#Sixty-seven cases of non ABO-HDN were confirmed from the suspected cases of HDN, Among which 45 males and 22 females were detected with the positive rate 1.48% and 0.72%, respectively. The mothers of 65 cases had two or more pregnancies. The detected irregular antibodies were mainly involved with Rh system, MNS system, Kidd system and Lewis system, among which Rh system accounted for 88.07% of the total antibody detection rate. Compared with that of ABO-HDN patients, the total bilirubin of non ABO-HDN patients developed more rapidly with a higher peak and a longer duration (P<0.001). In terms of serological detection, the positive rate of non ABO-HDN direct antibody test was 97.01%, which was higher than 47.00% of ABO-HDN (P<0.001), and the agglutination strength was often ≥ 2+, but there were still weak positive or negative cases of direct antibody test.@*CONCLUSION@#Non ABO-HDN caused by irregular antibodies mostly occurs in fetuses whose mothers experience multiple pregnancies, and the number of males is more than females. The irregular antibodies detected are mainly attributed to Rh system. The peak value of bilirubin in non ABO-HDN patients is higher and lasts longer than that in ABO-HDN patients. Direct antiglobulin test may be used to roughly distinguish ABO-HDN from non ABO-HDN.

Genetic analysis of mitochondrial pcox1 and ribosomal 18S rRNA genes in Eurytrema pancreaticum isolates from goats in Huaihua City, Hunan Province / 中国血吸虫病防治杂志

Objective To investigate the genetic variation of Eurytrema pancreaticum isolated from goats in Huaihua City, Hunan Province. Methods The partial sequence of mitochondrial cytochrome I (pcox1) and ribosomal 18S rRNA genes were amplified using a PCR assay in E. pancreaticum isolates from goats in Huaihua City, Hunan Province, and the PCR amplification products were sequenced. Then, the gene sequences were subjected to genetic variation and phylogenetic analyses. Results The sequences of the pcox1 and 18S rRNA genes were 430 bp and 1 857 bp in length in 18 E. pancreaticum isolates from goats in Huaihua City, Hunan Province, and there were 14 and 35 variation sites in pcox1 and 18S rRNA gene sequences, with intra-species genetic variations of 0 to 1.4% and 0 to 0.8%, respectively. The sequences of pcox1 and 18S rRNA genes had 99.0% to 99.8% and 99.5% to 99.8% homologies with those from E. pancreaticum Chinese strain recorded in the GenBank database. Consistent phylogenetic analysis results were found based on pcox1 and 18S rRNA genes. The 18 E. pancreaticum isolates from goats in Huaihua City were clustered into a clade with the known E. pancreaticum isolates registered in GenBank, and the clade with these 18 E. pancreaticum isolates was close to the clades with Eurytrema species and far from the clades with other trematodes. Conclusions The E. pancreaticum isolates from goats have a low genetic variation in Huaihua City, Hunan Province. Mitochondrial pcox1 and ribosomal 18S rRNA genes may serve as molecular markers for the studies on the genetic variation in goat-derived E. pancreaticum.

Analysis on clinical effects of two surgical approaches in percutaneous spinal endoscopy for LS disc herniation / 中国骨伤

OBJECTIVE@#To analyze the clinical effects, complications and operational key points of the percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating LS disc herniation.@*METHODS@#The clinical data of 158 patients with L5S1 disc herniation treated from July 2015 to March 2018 were restospectively analyzed. According to different surgical approaches, the patients were divided into PETD group or PEID group, 79 cases in each group. In PETD group, there were 41 males and 38 females, with an average age of (41.38±6.25) years and course of disease of (10.06±3.14) months. In PEID group, there were 43 males and 36 females, with an average age of (41.18±5.78) years and course of disease of (9.99±2.83) months. The operation length, intraoperative blood loss, intraoperative fluoroscopy times, days of hospital stay, and complications were recorded between two groups. Visual analogue score (VAS), Japanese Orthopedic Association(JOA) score, Oswestry Disability Index(ODI), modified Macnab criteria were used to assessed clinical effects after operation.@*RESULTS@#All patients completed surgery and were followed up for more than 1 year. (1) There were no significant differences in the intraoperative blood loss or hospitalization length between two groups(>0.05). The operation length and intraoperative fluoroscopy times in PETD group were significantly higher than in PEID group (0.05). (3)The excellence rate was 89.87% (71 / 79) in PETD group and 87.34% (69 / 79) in PEID group at the latest follow-up, with no statistical significance(>0.05). (4)Complications occurred in 2 cases in PETD group and in 3 cases in PEID group, with no significant differences between two groups.@*CONCLUSION@#The short term efficacy of the PETD is equal to that of the PEID for the LS disc herniation, but PEID is superior in the operation length, the access of stereotaxic puncture and intraoperative fluoroscopy times. The complications can be effectively reduced by following the indications, mastering the endoscopic technique, operating carefully and being familiar with the key points of common complications.

Loss-of-function of sox3 causes follicle development retardation and reduces fecundity in zebrafish

Folliculogenesis is essential for production of female gametes in vertebrates. However, the molecular mechanisms underlying follicle development, particularly apoptosis regulation in ovary, remain elusive. Here, we generated sox3 knockout zebrafish lines using CRISPR/Cas9. sox3 knockout led to follicle development retardation and a reduced fecundity in females. Comparative analysis of transcriptome between sox3 and wild-type ovaries revealed that Sox3 was involved in pathways of ovarian steroidogenesis and apoptosis. Knockout of sox3 promoted follicle apoptosis and obvious apoptosis signals were detected in somatic cells of stages III and IV follicles of sox3 ovaries. Moreover, Sox3 can bind to and activate the promoter of cyp19a1a. Up-regulation of Cyp19a1a expression promoted 17β-estradiol synthesis, which inhibited apoptosis in follicle development. Thus, Sox3 functions as a regulator of Cyp19a1a expression, via 17β-E2 linking apoptosis suppression, which is implicated in improving female fecundity.

Correlation Analysis of Platelet Aggregation Rate Detected by Platelet Analyzer, Platelet Aggregometer and Thromboelastography / 中国实验血液学杂志

OBJECTIVE@#To analyze and compare the correlation of platelet aggregation rate measured by platelet analyzer, platelet aggregometer and thromboelastography.@*METHODS@#The performance of platelet analyzer in platelet count and platelet aggregation function was evaluated. The platelet aggregation rate of 55 patients with type 2 diabetes mellitus (T2DM) before and after taking aspirin alone (32 cases) and clopidogrel alone (23 cases) was measured by thromboelastography, platelet aggregometer and platelet analyzer respectively, and the analytical results were compared. The correlation between the results measured by different instruments and equipment were further analyzed and the data were included in the statistical analysis.@*RESULTS@#The precision of platelet analyzer in day and in batch was 1/3 lower than the total error (7%). The contamination rate was 0.30%. The slope of regression equation was 1.02 and R was 0.99 in the linear range of 4.15×10/L to 1379.95×10/L. The coincidence rate of platelet count and platelet reference method was 85%, which met the requirements of industry standards. The platelet aggregation rates of patients with T2DM after clopidogrel or aspirin by using thromboelastography, platelet aggregometer and platelet analyzer respectively was significantly lower than those whom before clopidogrel administration (P<0.01).@*CONCLUSION@#Platelet analyzer can provide reliable, objective and accurate information for clinical detection of platelet count and aggregation function, which is meet the requirements of industry standards, and its results are similar to those of platelet aggregometer and thromboelastography.

Diagnostic Value of MPV, PDW, PAIg and Their Combination for Megakaryocyte Dysmaturity in Children with Acute Immune Thrombocytopenic Purpura / 中国实验血液学杂志

OBJECTIVE@#To investigate the changes of mean platelet volume (MPV), platelet distribution width (PDW) and platelet associated antibodies (PAIg) in children with acute immune thrombocytopenic purpura (aITP), and to explore the diagnostic value of MPV, PDW, PAIg and their combination for megakaryocyte dysmaturity in aITP children.@*METHODS@#Plt count, MPV and PDW of 36 aITP children were measured by using Sysmex XN automatic blood cell analyzer, and 33 children with acquired thrombocytopenic purpura (ATP) without megakaryocyte dysmaturity. The expression of PAIg was detected by flow cytometry, and the number and classification of megakaryocytes in the bone marrow were performed by marrow cytology. The diagnostic significances of MPV, PDW, PAIg and their combination as well as the sensitivity and specificity for megakaryocytes dysmaturity in aITP were assessed through calculating the area under ROC curve (AUC), after determining the influence of each parameters on the megakaryocyte dysmaturity by Logistic regression.@*RESULTS@#MPV, PDW and PAIg of aITP children were significantly higher than those of the ATP children (P＜0.05), while the Plt count and number of thromocytogenic megakaryocytes per area (1.5 cm×3 cm) were less than those of the controls (P＜0.05). Count of RBC and WBC, percentages of neutrophil granulocytes and lymphocydes in aITP were similar to those in the controls（P＞0.05）. The results of Logistic regression showed that Plt count, MPV, PDW and PAIg were the factors influencing megakaryocyte dysmaturity in aITP children, and the regression model has a high statistical significance (χ=65.491，P=0.001) and r square (R=0.713). The AUC of the combined detection of Plt count, MPV, PDW and PAIg was 0.863, which was much higher than that of Plt count, MPV, PDW, PAIg individually or in pairs. The sensitivity and specificity of the combined detection were 79.167% and 89.697%, which were higher than those of Plt count, MPV, PDW, PAIg individually or in pairs.@*CONCLUSION@#The diagnostic significance of MPV and PDW for megakaryocyte dysmaturity in aITP are insufficient, but the diagnostic efficacy can be improved by combined examination with PAIg.

Analysis of Screening Results in 501 Newborns with Hemolytic Disease / 中国实验血液学杂志

OBJECTIVE@#To explore the relationship between the serological detection of neonatal hemolytic disease (HDN) and related factors, and to observe the detection rate and specificity of the antibodies against the blood group in the newborn hemolytic disease.@*METHODS@#Maternal-neonatal blood type was detected firstly, and then the direct antiglobulin test(DAT), the free antibody test and the antibody release test were used to detect the occurrence of HDN; For those suspected hemolytic disease except ABO or direct DAT result over 2+, the indirect antiglobulin test with irregular antibody were used for screening cells and the plasma of the patient and mother, and then to detezmine whether there is a corresponding antigen in the red blood cells of the patient to confirm whether hemolytic disease of the other blood type system exists or not. The analysis was carried out by SPSS 22 software. The statistical analysis of classified data was tested by χ test. P<0.05 was considered as statistically significance.@*RESULTS@#A total of 501 cases of hyperbilirubinemia were collected. Among them 250 cases of HDN were diagnosed as HDN, and the detection rate was 49.90%.The detection rate of the male was 45.14%, and that of the female was 56.34%(χ =6.143, P<0.05). The average day-age of patients was 3.97±2.81 days. The analysis of relatianship between the detected rate of HDN and the day-age of HDN chilren showed that the day-age of HDN chilren affected the detected rate of HDN(χ =63.489, P<0.05). The analysis of positive rate of 3 test in HDN childen of every group found that the day-age had an infuence on the detected rate of direct antiglobulin test(χ=18.976，P<0.01) and also had an influence on the detected rate of the free antibody test(χ=9.650，P<0.05). The positive rate of the release test in HDN patients was highest（100%）. 244 cases suffered from ABO hemolysis, including 1 case of ABO hemolysis combined with Rh system (anti -E) hemolysis, 4 cases of Rh system (anti -D), 2 cases of MN system (1 case was caused by anti -M, 1 case was caused by low frequency anti -Mur). ABO HDN caused by anti-A or anti-B were not statisticaly significant.@*CONCLUSION@#Hemolytic disease of the newborn is a common cause of neonatal hyperbilirubinemia. The positive rate of HDN has a certain relations with the sexual distinction and the day-age. But there is no significant difference between anti-A and anti-B type. At the same time, screening and identification of irregular antibodies should be carried out to avoid diagnostic errors caused by undetected antibody when necessary.

Treatment efficacy of 153 cases of thyroid benign nodules by ultrasound-guided radiofrequency ablation / 西安交通大学学报(医学版)

Objective To evaluate the effectiveness ,safety and prospect of ultrasound-guided radiofrequency ablation (RFA) in treatment of thyroid benign nodules .Methods We analyzed 153 patients with thyroid benign nodules from September 2015 to August 2016 treated by RFA at Department of Thyroid Surgery ,the First Affiliated Hospital of Zhengzhou University . One month later , we reviewed the thyroid functions after the operation , observed the changes of the nodules after 1 ,3 ,and 6 months ,calculated the volume reduction rate of the nodules , and analyzed the effectiveness of the treatment .Results After treatment ,the maximum diameter and volume of the nodules were significantly reduced in all the patients ( P<0 .05) .The patients' symptoms improved significantly without serious complications . Conclusion Ultrasound-guided RFA has obvious advantages such as fewer complications , less invasiveness , good safety , and definite effectiveness in treating thyroid benign nodules . Therefore ,it has promising prospects in clinical application .

Curative effect of treatment with Octreotide for chylous leakage after neck dissection of thyroid carcinoma :Report of 14 cases / 西安交通大学学报(医学版)

Objective To observe the curative effects of treatment with Octreotide for chylous leakage after neck dissection .Methods We enrolled 14 patients with intractable chylous fistula treated at the First Affiliated Hospital of Zhengzhou University for the study .The curative effects of Octreotide treatment were retrospectively reviewed .Results Out of 14 patients with intractable chylous fistula ,12 (12/14 ,86% ) were finally cured and had the drainage tube removed .The drainage volume of 7 patients (7/14 ,50% ) decreased significantly by over 50%the next day of Octreotide medication ,but decreased insignificantly in 4 patients (4/14 ,29% ) .Conclusion Octreotid is an alternative method in treatment for intactable chylous fistula because of a satisfactory curative effect in some of the patients .

Characteristics of recurrent papillary thyroid cancer in metabolic syndrome patients / 西安交通大学学报(医学版)

Objective To explore the characteristics and components of recurrent papillary thyroid cancer in patients with metabolic syndrome .Methods We retrospectively reviewed the information of the patients with recurrent papillary thyroid cancer after initial surgery during January 1st ,2010 and December 31st ,2015 in the First Affiliated Hospital of Zhengzhou University .We compared tumor size ,lymph node metastasis ,recurrence time and postoperative invasion rate in metabolic syndrome and non-metabolic syndrome groups . Results Totally 82 patients were included with 34 men and 48 women .There was no significant difference between patients with and those without metabolic syndrome grouped by the classic diagnosis approach .However ,the lymph node metastasis grade of recurrent papillary thyroid cancer patients who also suffered from at least two metabolic disorders ,was lower ,especially in women (P=0 .002) .Moreover ,patients with metabolic disorders had shorter recurrence time (Pdiabetes=0 .034 , Pdyslipidemia =0 .037 , PBMI =0 .004 , PMetS2 =0 .036) .Conclusion Papillary thyroid cancer patients with metabolic disorder ,especially with two or more components of metabolic syndrome and overweight and/or obesity ,may have an increasing risk of recurrence .

Therapeutic evaluation of endoscopic and open thyroidectomy for papillary thyroid microcarcinoma / 西安交通大学学报(医学版)

Objective To evaluate the curative effects of endoscopic and open thyroidectomy for papillary thyroid microcarcinoma so as to explore the feasibility of endoscopic operation for papillary thyroid microcarcinoma . Methods We made a retrospective analysis of data of 98 cases of papillary thyroid microcarcinoma diagnosed pathologically between June 2016 and January 2017 in the First Affiliated Hospital of Zhengzhou University .All the patients were divided into two groups :52 in traditional operation group and 46 in endoscopic operation group . We analyzed the complications and the number of lymph nodes in the two groups . Results There was no significant difference in complications like voice hoarseness , hydroposia bucking and hypocalcemia between the two groups (P= 0 .6993 ,0 .9141 ,0 .5819 ,respectively) .Each patient had (5 .06 ± 3 .20) and (4 .80 ± 3 .19) lymph nodes in endoscopic operation group and traditional operation group ,respectively . No significant difference was found between the two groups (P=0 .6967) .Conclusion The traditional operation and endoscopic operation have similar curative effects for papillary thyroid microcarcinoma ,and the latter has better cosmetic effects .

Analysis of Success Rate and Influencing Factors for Collecting Peripheral Blood Hematopoietic Stem Cells by Combination of CTX or E-CHOP Chemotherapy with Mobilization of G-CSF in Patients with Multiple Myeloma / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the success rate and influencing factors for collecting peripheral blood hematopoietic stem cells (HSC) by combination of cyclophosphamide (CTX) or E-CHOP chemotherapy combined with granulocyte colony stimulating factor (G-CSF) in patients with multiple myeloma.</p><p><b>METHODS</b>The clinical data of 75 patients with multiple myeloma in our hospital were retrospectively analyzed. All patients received CTX or E-CHOP chemotherapy combined with G-CSF mobilization to collect HSC, and the success rate (CD34 cell numbers was at least 2×10/kg) and its influencing factors were statistically analyzed.</p><p><b>RESULTS</b>A total of 86 collections by mobilization were performed in 75 patients, with the average 3.22 (0.12-22.28)×10/kg of CD34 cells, and the success rate of 74.42%. Single factor analysis revealed that the course number of chemotherapy and disease status before the collection significantly correlated with the success rate of HSC collection (P<0.05), and sex, age, disease type, ISS stage and mobilization method showed no significant correlation with the collection success rate (P>0.05). Multivariate Logistic regression analysis showed that the course number of chemotherapy positively related with the success rate of HSC collection (OR=2.95, 95% CI: 1.60-5.41, P<0.01), and there was no significant correlation with the disease status before collection (OR=1.01, 95% CI: 0.88-1.16, P=0.89).</p><p><b>CONCLUSION</b>There are no significant effects of sex, disease type, ISS staging and mobilization methods on the success rate of HSC collection in patients with multiple myeloma, and the less course number of chemotherapy (<5) before collection show a higher success rate of HSC collection.</p>

Survival status of the surgical treatment of hilar cholangiocarcinoma patient / 中国现代普通外科进展

Objective:To investigate the survival status of the surgical treatment of hilar cholangiocarcinoma patient and related factors that influence long-term survival rate of patients.Methods:79 hilar cholangiocarcinoma patients in our hospital from June 2008 to March 2011 were selected and retrospectively analyzed,survival status of patients after 1,3,5 years was observed and recorded,clinic data was given simple factor and COX regression analysis.Results:From 79 hilar cholangiocarcinoma patients,there were 41 cases given surgical resection,38 cases given operative drainage,postoperative survival rate of all patients after 1,3,5 years were 49.37％ 、22.78％ 、7.59％,postoperative survival rate of patients with surgical resection after 1,3,5 years were 70.73％、36.59％ 、14.63％,postoperative survival rate of patients with operative drainage after 1,3,5 years were 26.32％、7.89％、0.00％.The difference of 5-year survival rate of patients with different pathological pattern,TNM stages,differentiated degree,surgical approach,excision method,lymphatic metastasis or not,different incisal edge had statistic significance (P ＜0.05).Mucinous carcinoma,TNM stages 1 ～ IV,operative drainage,palliative surgery,lymphatic metastasis were independent risk factors that influence survival status of hilar cholangiocarcinoma patients (P ＜ 0.05).Conclusion:The prognosis of surgical treatment of hilar cholangiocarcinoma patient is poor,mucinous carcinoma,TNM stages Ⅲ ～ IV,operative drainage,palliative surgery,lymphatic metastasis are independent risk factors that influence survival status of hilar cholangiocarcinoma patients.

Survival status of the surgical treatment of hilar cholangiocarcinoma patient / 中国现代普通外科进展

Objective:To investigate the survival status of the surgical treatment of hilar cholangiocarcinoma patient and related factors that influence long-term survival rate of patients.Methods:79 hilar cholangiocarcinoma patients in our hospital from June 2008 to March 2011 were selected and retrospectively analyzed,survival status of patients after 1,3,5 years was observed and recorded,clinic data was given simple factor and COX regression analysis.Results:From 79 hilar cholangiocarcinoma patients,there were 41 cases given surgical resection,38 cases given operative drainage,postoperative survival rate of all patients after 1,3,5 years were 49.37％ 、22.78％ 、7.59％,postoperative survival rate of patients with surgical resection after 1,3,5 years were 70.73％、36.59％ 、14.63％,postoperative survival rate of patients with operative drainage after 1,3,5 years were 26.32％、7.89％、0.00％.The difference of 5-year survival rate of patients with different pathological pattern,TNM stages,differentiated degree,surgical approach,excision method,lymphatic metastasis or not,different incisal edge had statistic significance (P ＜0.05).Mucinous carcinoma,TNM stages 1 ～ IV,operative drainage,palliative surgery,lymphatic metastasis were independent risk factors that influence survival status of hilar cholangiocarcinoma patients (P ＜ 0.05).Conclusion:The prognosis of surgical treatment of hilar cholangiocarcinoma patient is poor,mucinous carcinoma,TNM stages Ⅲ ～ IV,operative drainage,palliative surgery,lymphatic metastasis are independent risk factors that influence survival status of hilar cholangiocarcinoma patients.

Campylobacter jejuni AhpC protein B cell antigen epitope prediction and antigenic analysis / 中国人兽共患病学报

To provide evidence for Campylobacter jejuni (C.jejuni) vaccine research,the B cell epitope of AhpC protein were predicted,and the antigenicity was analyzed.AhpC was found locating in outer membrane of C.jejuni without transmem brane structure and no signal peptide by bioinformatics software TMHMM Server V2.0,SignalP 4.1.There were seven B-cell linear epitopes in AhpC predicted by IEDB.Then,the AhpC protein and chemically synthesized antigenic epitopes of C.jejuni were used as antigens,and the AhpC antibody of C.jejuni was used as the primary antibody,the antigens of predominant linear B cell epitopes were detected by ELISA and dot blot.Results showed that one epitope of B cell epitopes (AhpC4-16) was able to recognize the antibodies of C.jejuni AhpC and had strong antigenicity,indicating that could be used in the follow-up vaccine research.

Contrast enhanced ultrasound applied for evaluation of high intensity focused ultrasound in treat- ment of rabbit VX2 liver cancer model / 上海预防医学

[ Objective] To explore the variation features of contrast enhanced ultrasound ( CEUS) quantitative parameters and its correlation with tumor microvessel density ( MVD ) , after the treatment of living liver cancer using high intensity focused ultrasound ( HIFU ) . [ Methods ] A group of 30 New Zealand white rabbits were made into VX2 liver cancer models, that were randomly divided into control group ( n =15, not HIFU treatment) and treatment group ( n =15, HIFU treatment).CEUS was performed, then obtaining ascending slope(AS),arrival time(AT),time-to-peak(TTP),peak intensity ( PI) ,area under curve ( AUC ) .And correlation analysis was performed with MVD obtained by immune histochemical method. [ Results ] Compared with those in the control group, AS, PI, AUC were significantly decreased in treatment group (P <0.05) and so was MVD (P <0.05).AT,TTP were significantly delayed than those in the control group (P<0.05).The AS, PI, AUC of CEUS quantitative parameters were positively correlated with MVD (P<0.05).The AT, TTP respectively showed a negative correlation with MVD ( P<0.05) . [ Conclusion] CEUS quantitative parameters of liver cancer tissue have high correlation with MVD.It can reflect the microvessel structure change of the liver cancer tissue and help to judge the curative effect and prognosis of HIFU for liver cancer.

Application of“top-down” method in assessment of measurement uncertainty of biochemical detection indicators / 国际检验医学杂志

Objective To investigate the application of “top-down” method in assessment of measurement uncertainty of bio-chemical detection indicators .Methods The assessment data of internal quality control and external quality and “top-down”method were used to assess the precision and accuracy of 26 biochemical indicators ,and the two variables above were combined to calculate the measurement uncertainty .Results Uncertainty of 18 biochemical indicators was compatible with the target uncertainty ,ac-counting for approximately 69 .2% of all assessment projects .Five indicators ,such as TBIL ,albumin ,CK ,calcium and magnesium , was not compatible with the target uncertainty ,accounting for approximately 19 .2% of all assessment projects .Conclusion The“top-down” method is effective and feasible for assessment of measurement uncertainty of biochemical detection indicators .

Structured lipid emulsion as nutritional therapy for the elderly patients with severe sepsis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The nutritional support is one of the important therapeutic strategies for the elderly patients with severe sepsis, but there is controversial in choosing a parenteral nutrition formulation. This study was designed to compare the therapeutic effects of structured lipid emulsion, physically mixed medium, and long-chain fat emulsion in the treatment of severe sepsis in elderly patients.</p><p><b>METHODS</b>A total number of 64 elder patients with severe sepsis were enrolled in the study. After a week of enteral nutritional support, the patients were randomly divided into research (structured lipid emulsion as parenteral alimentation) and control groups (physically mixed medium and long-chain fat emulsion as parenteral alimentation). The alterations of plasma albumin, lipid metabolism, and blood glucose level were recorded after parenteral alimentation and were compared between the two groups.</p><p><b>RESULTS</b>The plasma levels of albumin, prealbumin, cholesterol, and triglyceride were decreased in all the patients after one week of enteral nutritional support treatment (t = 7.78, P = 0.000; t = 10.21, P = 0.000; t = 7.99, P = 0.000; and t = 10.99, P = 0.000). Further parenteral alimentation with different lipid emulsions had significant effects on the serum prealbumin and albumin (t = 3.316, P = 0.002; t = 3.200, P = 0.002), whilst had no effects on the blood glucose and triglyceride level (t = 7.78, P = 0.000; t = 4.228, P = 0.000). In addition, the two groups had a significantly different Apache II score, ventilator time, and hospital stay time (t = -2.213, P = 0.031; t = 2.317, P = 0.024; t = 2.514, P = 0.015).</p><p><b>CONCLUSIONS</b>The structured lipid emulsion was safe as parenteral nutrition for elderly patients with severe sepsis. It was demonstrated to be superior to the physically mixed medium and long-chain fat emulsion with respect to the protein synthesis and prognosis.</p>