Incidence and risk factors of postoperative delirium in liver transplantation recipients: a Meta-analysis / 中华器官移植杂志

Objective:To clarify the incidence and the related risk factors of postoperative delirium in liver transplantation (LT) recipients to provide rationales for early identification of delirium and constructing the related models.Methods:The authors used the "肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"and "liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"as the Chinese and English keywords, searching Wanfang data, China Biomedical Literature Database, CNKI, PubMed, Embase, Web of Science, Cochrane Library, BMJ and the literature for the incidence or risk factors of postoperative delirium in LT recipients. The researchers independently performed literature screening, methodological evaluation and data extraction. And RevMan 5.4 and State16.0 software were employed for data processing.Results:A total of 19 articles involving 5003 samples were retrieved and 22 risk factors identifies. Meta-analysis showed that the incidence of POD was 23%(1151/5003). The statistically significant risk factors included preoperative blood ammonia concentration >46 mmol/L ( OR=3.51, 95% CI: 1.53-8.09, P<0.001), model for end-stage liver disease (MELD) score >15 points ( OR=4.24, 95% CI: 2.51-7.16, P<0.001), preoperative hepatic encephalopathy ( OR=3.00, 95% CI: 2.09-4.31, P<0.001), preoperative dosing of diuretics ( OR=2.36, 95% CI: 1.38-4.04, P<0.001), history of alcoholism ( OR=3.16, 95% CI: 1.06-9.40, P=0.040), longer anhepatic period ( OR=1.04, 95% CI: 1.03-1.06, P<0.001) and elevated aspartate transaminase concentration at Day 1 post-operation ( OR=1.33, 95% CI: 1.15-1.53, P<0.001). Conclusions:Preoperative blood ammonia concentration >46 mmol/L, MELD score >15, hepatic encephalopathy, dosing of diuretic, a history of alcoholism, longer anhepatic period and elevated aspartate transaminase at Day 1 post-operation are risk factors for postoperative delirium after LT. Postoperative reintubation is not a risk factor for postoperative delirium.

Progress in pulmonary enteric adenocarcinoma / 中华肿瘤杂志

Pulmonary enteric adenocarcinoma (PEAC), as a rare histologic subtype of primary lung adenocarcinoma, is defined as an adenocarcinoma in which the enteric component exceeds 50%. It is named after its shared morphological and immunohistochemical features with colorectal cancer. While with such similarity, the differential diagnosis of PEAC and lung metastatic colorectal cancer is a great challenge in the clinic. PEAC may originate from the intestinal metaplasia of respiratory basal cells stimulated by risk factors such as smoking. Current studies have found that KRAS is a relatively high-frequency mutation gene, and other driver gene mutations are rare. In terms of immunohistochemistry, in pulmonary enteric adenocarcinoma, the positive rate was 88.2% (149/169) for CK7, 78.1% (132/169) for CDX2, 48.2% (82/170) for CK20 and 38.8% (66/170) for TTF1. As for clinical features, the average age of onset for pulmonary enteric adenocarcinoma was 62 years, male patients accounted for 56.5% (35/62), smokers accounted for 78.8% (41/52), and 41.4% (24/58) of the primary lesion was located in the upper lobe of the right lung. In terms of treatment, conventional non-small cell lung cancer (NSCLC) regimens rather than colorectal cancer regimens are now recommended. There is still an urgent need for more basic and clinical research, in-depth exploration of its molecular feature and pathogenesis from the level of omics and other aspects, to help diagnosis and differential diagnosis, and find the optimal chemotherapy regimen, possibly effective targeted therapy and even immunotherapy.

Clinical Efficacy of Modified Sanzi Yangqintang and Colon Hydrotherapy on Treatment of Non-alcoholic Fatty Liver Disease with Phlegm-dampness / 中国实验方剂学杂志

Objective::To explore the clinical efficacy of modified Sanzi Yangqintang combined with colon hydrotherapy in the treatment of non-alcoholic fatty liver disease (NAFLD) with phlegm-dampness. Method::Totally 100 patients with NAFLD were selected and randomly divided into treatment group (50 cases) and control group (50 cases). Both groups were orally given silybin and glycyrrhizic acid diamine capsules.The treatment group was also added with modified Sanzi Yangqintang and colon hydrotherapy.The treatment lasted for 7 days.The control group was also added with saline colon hydrotherapy.Main traditional Chinese medicine (TCM) syndrome scores and liver function indexes before and after treatment [alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamate transpeptidase (GGT)], blood lipid routine [cholesterol (TCH), triglyceride (TG)], inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], FibroScan measurement [liver stiffness measurement (LSM), controlled attenuation parameters (CAP)], uric acid and body weight changes were observed.Adverse reactions were observed, and the patient's medication safety was evaluated. Result::TCM syndrome score, liver enzyme index, blood lipid index, inflammatory factor index, FibroScan CAP, uric acid and body weight of the two groups were significantly reduced than those before treatment(P<0.05, P<0.01) .There was no significant difference in liver enzymes, TCH, IL-6 and LSM between treatment group and control group.And TCM syndrome scores, UA, TNF-α, FibroScan CAP decreased were significantly different from control group (P<0.05). Conclusion::Modified Sanzi Yangqintang combined with colon hydrotherapy can not only alleviate NAFLD with phlegm-dampness symptoms, but also significantly reduce triglyceride, tumor necrosis factor and FibroScan CAP and body mass, with certain clinical efficacy in a short term.

Mechanism of Huanglian Ejiao Tang on Prevention and Treatment of Myocardial Injury Induced by Anthracycline Chemotherapy Drugs / 中国实验方剂学杂志

Objective: To observe the preventive and therapeutic effect of Huanglian Ejiao Tang on myocardial injury induced by anthracycline chemotherapeutic drugs in all kinds of cancer patients undergoing chemotherapy. Method:We chosen all kinds of cancer patients with combined use of anthracycline chemotherapy drugs in our hospital, 21 days as one cycle. The cardiac toxicity reaction was observed after three continuous chemotherapy cycles. A total of 64 patients who met the dialectical criteria of "imbalance between heart-Yang and kidney-Yin" were randomly divided into treatment group (32 cases) and control group (32 cases). Patients in treatment group were treated with Chinese medicine Huanglian Ejiao Tang based on original chemotherapy regimen, adding and subtracting Chinese medical materials according to the symptoms. Patients in control group continued to maintain the original chemotherapy regimen, and both two groups of patients continued to receive 3 cycles of continuous chemotherapy. By comparing the cardiac function classification and cardiac function tolerance between the 3 cycles and 6 cycles of two groups of patients after chemotherapy; changes of echocardiography index, QTc interval, creatine kinase isoenzyme (CK-MB), Myoglobin (MYO), cardiac troponin I (cTNI)and nitrogenous terminal-pro-brain natriuretic peptide(NT-pro-BNP) concentration value were compared between two groups; and the concentrations of adrenaline (E), norepinephrine (NE) and angiotensin Ⅱ(AngⅡ) were observed and compared; meanwhile, the correlation analysis was carried out at the same time. Result:After 6 cycles of chemotherapy in Chinese medicine treatment group, degree of cardiac function classification and the 6 minute walking heart function tolerance were significantly better than those at the 3 cycles of chemotherapy (PPPPPConclusion:Huanglian Ejiao Tang can reduce the excitability of the symppthetic nervous system (SNS) and renin-angiotensin system(RAS) in human body and inhibit the release level of NE, E and AngⅡ by effect of "invigorating the kidney and clearing the heart". It has a certain preventive and treatment effect on the cardiac toxicity of patients with the cumulative use of anthracycline chemotherapy. To a certain extent, it can inhibit myocardial injury, improve cardiac function and reduce the incidence of cardiovascular events.

Isolation and phylogenetic analysis of hemagglutinin gene of H9N2 influenza viruses from chickens in South China from 2012 to 2013

As part of our ongoing influenza surveillance program in South China, 19 field strains of H9N2 subtype avian influenza viruses (AIVs) were isolated from dead or diseased chicken flocks in Guangdong province, South China, between 2012 and 2013. Hemagglutinin (HA) genes of these strains were sequenced and analyzed and phylogenic analysis showed that 12 of the 19 isolates belonged to the lineage h9.4.2.5, while the other seven belonged to h9.4.2.6. Specifically, we found that all of the viruses isolated in 2013 belonged to lineage h9.4.2.5. The lineage h9.4.2.5 viruses contained a PSRSSRdownward arrowGLF motif at HA cleavage site, while the lineage h9.4.2.6 viruses contained a PARSSRdownward arrowGLF at the same position. Most of the isolates in lineage h9.4.2.5 lost one potential glycosylation site at residues 200-202, and had an additional one at residues 295-297 in HA1. Notably, 19 isolates had an amino acid exchange (Q226L) in the receptor binding site, which indicated that the viruses had potential affinity of binding to human like receptor. The present study shows the importance of continuing surveillance of new H9N2 strains to better prepare for the next epidemic or pandemic outbreak of H9N2 AIV infections in chicken flocks.

Expression of ILK and PKB/Akt in acute leukemia and its significance / 中国实验血液学杂志

The aim of this study was to investigate the expression of integrin linked kinase (ILK) and protein kinase B (PKB/Akt) in acute leukemia (AL), explore the possible effects of ILK/Akt pathway on AL pathogenesis. The expression level of ILK mRNA and Akt mRNA in different types and stages of AL bone marrow mononuclear cells was detected by reverse transcription polymerase chain reaction (RT-PCR). The results showed that the expression of ILK and Akt in do nove AL group was higher than that in AL-CR group and normal control group (P < 0.05), while there was no statistically difference between de nove AL and relapsed AL groups (P > 0.05). The expression of ILK positively correlates with Akt expression in de nove AL group (P < 0.05). It is concluded that the expression of ILK and Akt mRNA is abnormally higher in AL, ILK/Akt pathway may be involved in the pathogenesis and progression of AL and may be a potential therapeutic target for AL.

Primary co-culture of cortical neurons and astrocytes of new-born SD rats / 药学学报

This study is to establish a simple and practical co-culture method of cortical neurons and astrocytes of rats. The cortex of the new-born SD rats was digested by 0.125% pancreatic enzyme, and the differential adherence was applied to obtain the mixed cell suspension of neurons and astrocytes. A low concentration of cytarabine was used to inhibit the astrocytes in a moderate way to get neuronal and astrocyte co-culture. The morphological characteristics of the cells in different times were observed under the inverted microscope. The cells began to adhere the wall 2 h after the inoculation. Neurons and astrocytes grew in a good condition under the inverted microscope 9 days after the inoculation. The results of the immunofluorescence staining and Rosenfeld's staining indicated that the co-culture of neurons and astrocytes was successful and the ratio of neurons and astrocytes was close to 1:1. A new neurons and astrocytes co-culture method, which is simple and convenient, was successfully established. It will be an efficient method for the related researches about neuronal and astrocyte co-culture in vitro.

successful diagnosis of acute pulmonary embolism

Diagnosis of pulmonary embolism [PE] remains a major clinical problem. If there is no obviously reason to define enlargement of right atrium and ventricle, PE should be suspected. In this report, we describe a successful diagnosis of acute pulmonary embolism in an elderly patient

Analysis of clinical effect of Brevisapine injection on high sensitivity C-reaction protein level in the treatment of acute myocardial infarction / 中国综合临床

Objective To analyze the clinical effect of brevisapine injection on high sensitivity C-reaction protein level in the treatment of acute myocardial infarction.Methods The patients were randomly divided into treatment group(n=80)and control group(n=80).Both groups were treated with routine midication,but treatment group were given intravenous drip of 100 mg brevisapine once a day.for 14 days.80 paients who came for diagnosis were selected for healthy control group.The selqlm high sensitivity C-reaction protein levels were measured at 2 d,7 d,and 14 d by ELLSA in treatment group,control group and healthy control group.Mortality,heart function status (Killip class),revaseularization and clinical adverse cardic events including postinfartion angina,new arrhythmia,reinfarction and bleeding complication at 4 weeks were observed.Results Treatment group had a significantly high level of hs-CRP compared with healthy subjects[(6.37±1.43)vs.(2.17±1.12)mmol/L,P＜0.01]at the second day.The serum hs-CRP content of treatment group was obviously lower than that of control group(3.21±1.31)and(2.25±0.34)mmol/L vs.(5.87±1.16)、(3.97±1.21)mmol/L,(P＜0.01)]on the 7th,14th days;The revascularization rate of treatment group was obviously higher than that of control group[62.50%(50/80)vs.51.25% (45/80),P ＜0.01];There was no difference between the two groups in mortality(3.75% vs.4.10%,P ＞0.05).No difference was found in the rate of bleeding between the two groups(6.25% vs.7.50%,P ＞0.05);Patients with Killip class＜Ⅱ of treatment group was obviously higher than that of control group (83.75% vs 61.25%,P ＜ 0.05 );Clinical adverse cardic events rates at 4 weeks of treatment group were obviously lower than those of control group (P ＜ 0.01 ).No obvious adverse reactions related to the treatment group were observed.Condusion The serum hs-CRP level is in close relation with acute myocardial infarction,which is the risk factor.It is effective and safe of brevisapine injection in the treatment of acute myocardial infarction.The effects of brevisapine on acute myocardial infarction might be involved in decreasing the level of hs-CRP and inhibiting the vascular inflammatory reaction.

Phylogenetic and characteristic analysis of 16S rDNA and rpoB gene sequence of Klebsiella / 中华微生物学和免疫学杂志

Objective To compare and analyze the phylogenetic tree and sequence variant characteristics of Klebsiella species between 16S rDNA and rpoB. Methods Eighteen isolates identified as genus Klebsiella (with 15 of K. Pneumoniae and 3 of K. Oxytoca) by automated biochemical tests were selected. DNA were extracted, 16S rDNA and rpoB genes were amplified and sequenced with Klebsiella 16S rDNA and rpoB primers. Together with already published 8 species of Klebsiella and 9 species of Enterobacteriaceae 16S rDNA and rpoB sequences from GenBank, totally 35 sequences of 16S rDNA and rpoB respectively, phylogenetic trees were constructed with MEGA 4.0 to the analysis of groups. DNAStar/MegAlign was used for comparison of variable regions of 16S rDNA and rpoB, with analysis of degree of divergent at the same time. Results As for all 35 sequences, both 16S rDNA and rpoB phylogenetic trees divided Klebsiella species into three groups, 15 of K. Pneumoniae in this study and 6 of K. Pneumoniae from GenBank (except for K. Oxytoca and K. Mobilis) cluster to group Ⅰ, K. Oxytoca and K. Mobilis were cluster to group Ⅱ and Ⅲ, respectively. In rpoB phylogenetic tree, no matter group Ⅰ and group Ⅱ, or subgroup within group Ⅰ, the bootstrap values in each node of rpoB phylogenetic tree is obviously higher than that of 16S rDNA. Moreover, as for cluster to K. Oxytoca, rpoB is better than 16S rDNA. Analysis nucleic acid sequences of Klebsiella species, with 41 variable regions and 4 most significant regions were found within the Klebsiella 16S rDNA, while rpoB with 63 variable regions, and 1 most significant region. The similarity of 16S rDNA and rpoB within Klebsiella were 95.9%-100% and 90.2%-100% respectively. Further analysis divergent degree of 16S rDNA and rpoB within Klebsiella, the divergent value of rpoB (0-10.6) is higher than that of the 16S rDNA(0-4.0). Conclusion As for molecular classification and identification within KlebsieUa species, rpoB has more advantages than 16S rDNA.

Isolation, identification and 16S rDNA phylogenetic analysis of Klebsiella pneumonia from diarrhea specimens / 中华流行病学杂志

Objective To understand the biochemical characteristics and 16S rDNA genetic sequence evolution of strains isolated from diarrhea specimens so as to provide basis for classification and identification of Klebsiella pneumoniae. Methods Specimens were cultured using MacConkey and SS medium. All isolates were identified as K. pneumoniae by automated biochemical tests. DNA was extracted, 1500 bp fragments of the 16S rDNA gene were by amplified PCR and sequenced with K. pneumoniae 16S rDNA primer, after being cut. Fragments of 1000 bp overlapping sequences were analyzed by Blastn to confirm the identity of the isolates. A phylogenetic tree was constructed by PHYLIP process to analyze the 16S rDNA sequence of the isolated strain with other relative bacteria species in the GenBank databases. Results Among 113 specimens of infectious diarrhea, 25 K. pneumoniae strains were identified by biochemical tests, of which 21 subsp, pneumoniae and 4 subsp, ozaenae, no subsp, of rhinoseleroma were isolated. Strains of subsp, pneumoniae were found having nature of resistance. All isolates were resistant to penicillin G and susceptible to polymyxin with some strains were resistant to Nitrofurantoin, Cephalothin, Kanamycin, Tobramycin. After searching in GenBank of 16S rDNA, strains biochemical identified as subsp, ozaenae shared high similarity with Salmonella strains and other intestinal bacteria. 16S rDNA phylogenetie analysis could be used to confirm subsp, pneumoniae, but could not separate other subspecies of K. pneumoniae completely. Conclusion 16S rDNA phylogenetic analysis useful in identifying and classifying K. pneumoniae.

Clinical comparison of the sensitivity and specificity of cardiac troponin I and cardiac troponin T and creatine kinase MB for the early diagnosis of acute myocardial infarction / 中国综合临床

Objective To observe the application value of cardiac troponin I (cTnI),cardiac troponin T (cTnT) and creatine kinase MB (CK MB) for the early diagnosis of acute myocardial infarction (AMI).Methods The same serum sample was measured to detect the indexes of cTnI,cTnT and CK MB levels in 60 patients with AMI and 40 patients with UA.Comparison between AMI and UA was performed and all the indexes were analysed contrastively.Results The sensitivity of cTnI and cTnT was higher than that of CK MB,and their positive rates were 63.3%,46.7% and 18.3% respectively (P0.05) and the specificity of the three indexes were almost the same without significant difference.Conclusion cTnI and cTnT,as specific markers of cardiac damage,are more sensitive and specific in the early diagnosis of AMI.As a convenient,swift and accurate measurement method,cTnI has significant clinical value.